Provider Demographics
NPI:1265936801
Name:LIFE OPTIONS OF WEST TN, INC
Entity type:Organization
Organization Name:LIFE OPTIONS OF WEST TN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:KNOX
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-623-0634
Mailing Address - Street 1:2600 POPLAR AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3835
Mailing Address - Country:US
Mailing Address - Phone:901-347-3972
Mailing Address - Fax:901-907-0299
Practice Address - Street 1:2600 POPLAR AVE STE 112
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3835
Practice Address - Country:US
Practice Address - Phone:901-347-3972
Practice Address - Fax:901-907-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management