Provider Demographics
NPI:1558612226
Name:PHOENIX EQUESTRIAN CENTER LLC
Entity Type:Organization
Organization Name:PHOENIX EQUESTRIAN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-516-4016
Mailing Address - Street 1:141 MENEES LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5801
Mailing Address - Country:US
Mailing Address - Phone:615-516-4016
Mailing Address - Fax:888-332-0301
Practice Address - Street 1:146 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-8411
Practice Address - Country:US
Practice Address - Phone:615-516-4016
Practice Address - Fax:888-332-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty