Provider Demographics
NPI:1942807235
Name:HAMMOCK, NATASHA LYNN
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:LYNN
Last Name:HAMMOCK
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 1:6842 NORTHKNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-3040
Mailing Address - Country:US
Mailing Address - Phone:901-501-4774
Mailing Address - Fax:
Practice Address - Street 1:6842 NORTHKNOLL AVE
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-3040
Practice Address - Country:US
Practice Address - Phone:901-501-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN853294265OtherMENTAL HEALTH COUNSELOR
TN853294265OtherCASH PAYMENTS