Provider Demographics
NPI:1396218053
Name:CHRISMAN, KIMBERLY (CPRS, LAADAC TRACK)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:CPRS, LAADAC TRACK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 HARRAH DR STE T
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6254
Mailing Address - Country:US
Mailing Address - Phone:615-614-1300
Mailing Address - Fax:615-614-1336
Practice Address - Street 1:3011 HARRAH DR STE T
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6254
Practice Address - Country:US
Practice Address - Phone:615-614-1300
Practice Address - Fax:615-614-1336
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000679101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)