Provider Demographics
NPI:1831913334
Name:MANA SPRINGS PSYCHIATRIC CARE, LLC
Entity type:Organization
Organization Name:MANA SPRINGS PSYCHIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMUSU
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:615-852-6256
Mailing Address - Street 1:133 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:931-903-1200
Practice Address - Street 1:133 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3437
Practice Address - Country:US
Practice Address - Phone:615-852-6256
Practice Address - Fax:931-903-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty