Provider Demographics
NPI:1821455742
Name:CENTER FOR MARRIAGE & FAMILY HEALTH
Entity Type:Organization
Organization Name:CENTER FOR MARRIAGE & FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUMOKE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:OTUNO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-496-0821
Mailing Address - Street 1:5007 HECTARE LN
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2598
Mailing Address - Country:US
Mailing Address - Phone:615-496-0821
Mailing Address - Fax:615-676-1497
Practice Address - Street 1:98 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3033
Practice Address - Country:US
Practice Address - Phone:615-496-0821
Practice Address - Fax:615-676-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMFT702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty