Provider Demographics
NPI:1417334061
Name:CENTERSTONE OF TENNESSEE INC
Entity Type:Organization
Organization Name:CENTERSTONE OF TENNESSEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOBILE CRISIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:931-801-3175
Mailing Address - Street 1:1820 MEMORIAL CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4539
Mailing Address - Country:US
Mailing Address - Phone:931-801-3175
Mailing Address - Fax:
Practice Address - Street 1:1820 MEMORIAL CIR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4539
Practice Address - Country:US
Practice Address - Phone:931-801-3175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health