Provider Demographics
NPI:1821115528
Name:STRATEGIES FOR LIFE OF TENNESSEE LLC
Entity Type:Organization
Organization Name:STRATEGIES FOR LIFE OF TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-423-4150
Mailing Address - Street 1:109 JORDAN DR
Mailing Address - Street 2:SUITES A-D
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7707
Mailing Address - Country:US
Mailing Address - Phone:423-553-1400
Mailing Address - Fax:423-553-1444
Practice Address - Street 1:109 JORDAN DR
Practice Address - Street 2:SUITES A-D
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7707
Practice Address - Country:US
Practice Address - Phone:423-553-1400
Practice Address - Fax:423-553-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000008511261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0444648Medicaid
44-4468OtherMEDICARE PTAN