1942037288 NPI number — ESSENTIAL MENTAL WELLNESS, PLLC

Table of content: (NPI 1942037288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942037288 NPI number — ESSENTIAL MENTAL WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESSENTIAL MENTAL WELLNESS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942037288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1992
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37024-1992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-260-8058
Provider Business Mailing Address Fax Number:
615-468-4660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 N THOMPSON LN STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-4340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-260-8058
Provider Business Practice Location Address Fax Number:
615-468-4660
Provider Enumeration Date:
09/19/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT/CEO/PHYSICIAN
Authorized Official Telephone Number:
615-260-8058

Provider Taxonomy Codes

  • Taxonomy code: 2084A0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)