| Calm Place | |
|
170 Smithfield Dr Jackson TN 38305-1817 | |
| (731) 300-1117 | |
| (731) 265-6028 |
| Full Name | Calm Place |
|---|---|
| Speciality | Social Worker |
| Location | 170 Smithfield Dr, Jackson, Tennessee |
| Authorized Official Name and Position | Susan Lovelace (CREDENTIALING) |
| Authorized Official Contact | 7314107719 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Calm Place 170 Smithfield Dr Jackson TN 38305-1817 Ph: (731) 300-1117 | Calm Place 170 Smithfield Dr Jackson TN 38305-1817 Ph: (731) 300-1117 |
| NPI Number | 1407500655 |
|---|---|
| Provider Enumeration Date | 02/07/2022 |
| Last Update Date | 02/07/2022 |
| Certification Date | 02/07/2022 |
| Medicare PECOS PAC ID | 0547648248 |
|---|---|
| Medicare Enrollment ID | O20220609000140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407500655 | NPI | - | NPPES |
| Q037696 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kimberly Fowler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831245166 PECOS PAC ID: 3476803461 Enrollment ID: I20180912003741 |
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