Provider Demographics
NPI:1568611879
Name:SEQUEL SCHOOLS LLC DBA SEQUELCARE OF TENNESSEE
Entity Type:Organization
Organization Name:SEQUEL SCHOOLS LLC DBA SEQUELCARE OF TENNESSEE
Other - Org Name:KIDS 1ST OF TENNESSEE, LLC OR CAMELOT OF TENNESSEE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:615-849-3939
Mailing Address - Street 1:1131 EAGLETREE LANE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:534 UPTOWN SQUARE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-849-3939
Practice Address - Fax:615-849-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
TNL000000008454251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508362Medicaid