Provider Demographics
NPI:1417510363
Name:REFORM PSYCHIATRY LLC
Entity Type:Organization
Organization Name:REFORM PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEMIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:207-530-0461
Mailing Address - Street 1:433 NISSAN DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4360
Mailing Address - Country:US
Mailing Address - Phone:615-751-0347
Mailing Address - Fax:615-249-5162
Practice Address - Street 1:433 NISSAN DR STE 301
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-751-0347
Practice Address - Fax:615-249-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ049227Medicaid