Provider Demographics
NPI:1770078040
Name:NOVUS BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NOVUS BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SCARLETT
Authorized Official - Middle Name:CAE
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:931-820-0242
Mailing Address - Street 1:130 HILLCREST DR STE 213
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5083
Mailing Address - Country:US
Mailing Address - Phone:931-820-0242
Mailing Address - Fax:
Practice Address - Street 1:130 HILLCREST DR STE 213
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5083
Practice Address - Country:US
Practice Address - Phone:931-820-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty