Provider Demographics
NPI:1699202457
Name:CROSBY-POWELL, JELESSA LASHAE
Entity Type:Individual
Prefix:
First Name:JELESSA
Middle Name:LASHAE
Last Name:CROSBY-POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JELESSA
Other - Middle Name:
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2010 TYNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5284
Mailing Address - Country:US
Mailing Address - Phone:618-501-7109
Mailing Address - Fax:
Practice Address - Street 1:2010 TYNEWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5284
Practice Address - Country:US
Practice Address - Phone:618-501-7109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness