Provider Demographics
NPI:1699416636
Name:BROWN BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:BROWN BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:AVANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:731-228-9068
Mailing Address - Street 1:623 MOSS LN
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1074
Mailing Address - Country:US
Mailing Address - Phone:901-864-9563
Mailing Address - Fax:
Practice Address - Street 1:623 MOSS LN
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1074
Practice Address - Country:US
Practice Address - Phone:901-864-9563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)