Provider Demographics
NPI:1336596584
Name:SOUTHLAND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SOUTHLAND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-521-9097
Mailing Address - Street 1:9220 PARK WEST BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4405
Mailing Address - Country:US
Mailing Address - Phone:865-247-6754
Mailing Address - Fax:
Practice Address - Street 1:9220 PARK WEST BLVD STE 1
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4405
Practice Address - Country:US
Practice Address - Phone:865-247-6754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20770OtherTENNESSEE STATE LICENSE NUMBER
TN20770OtherTENNESSEE STATE LICENSE NUMBER