Provider Demographics
NPI:1851700272
Name:CANTRELL, LENA
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 ARCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-4744
Mailing Address - Country:US
Mailing Address - Phone:931-647-8257
Mailing Address - Fax:931-647-2978
Practice Address - Street 1:118 UNION ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5115
Practice Address - Country:US
Practice Address - Phone:931-564-7825
Practice Address - Fax:931-647-2978
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness