Provider Demographics
NPI:1912199167
Name:LLOYD C. ELAM MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:LLOYD C. ELAM MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR AND CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKPAKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-6824
Mailing Address - Street 1:1005 DAVID B. TODD JR. BLVD.
Mailing Address - Street 2:LLOYD C. ELAM MENTAL HEALTH CENTER
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1005 DAVID B. TODD JR. BLVD.
Practice Address - Street 2:LLOYD C. ELAM MENTAL HEALTH CENTER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208
Practice Address - Country:US
Practice Address - Phone:615-327-6255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000324261QM0850X, 261QM0855X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health