Provider Demographics
NPI:1790131340
Name:VERTREES CLINICAL GROUP, PLLC
Entity Type:Organization
Organization Name:VERTREES CLINICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VERTREES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-784-4056
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-0464
Mailing Address - Country:US
Mailing Address - Phone:615-784-4056
Mailing Address - Fax:615-858-1500
Practice Address - Street 1:1550 N MOUNT JULIET RD STE 104
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3786
Practice Address - Country:US
Practice Address - Phone:615-784-4056
Practice Address - Fax:615-858-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19298363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty