Provider Demographics
NPI:1407341753
Name:PHO LLC
Entity Type:Organization
Organization Name:PHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC MHSP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:HINTON OSWALT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC MHSP
Authorized Official - Phone:205-504-1587
Mailing Address - Street 1:6069 FRONTIER LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6220
Mailing Address - Country:US
Mailing Address - Phone:205-504-1587
Mailing Address - Fax:
Practice Address - Street 1:100 WINNERS CIR N STE 120
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5012
Practice Address - Country:US
Practice Address - Phone:205-504-1587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15135261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health