Provider Demographics
NPI:1659984680
Name:THE INNER PHENOMENON, LLC
Entity Type:Organization
Organization Name:THE INNER PHENOMENON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-825-7142
Mailing Address - Street 1:9808 AVERBURY DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0656
Mailing Address - Country:US
Mailing Address - Phone:901-825-7142
Mailing Address - Fax:
Practice Address - Street 1:9808 AVERBURY DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0656
Practice Address - Country:US
Practice Address - Phone:901-825-7142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty