Provider Demographics
NPI:1629695366
Name:CRAFT, BENJAMIN CHISUM JASON
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CHISUM JASON
Last Name:CRAFT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FRANKLIN ROAD, SUITE 135
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-412-1155
Mailing Address - Fax:
Practice Address - Street 1:155 FRANKLIN RD STE 135
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4646
Practice Address - Country:US
Practice Address - Phone:615-412-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health