| Eagles Passage Therapeutic Farm, Llc | |
|
2605 Riddle Rd New Market TN 37820-4835 | |
| (865) 932-3331 | |
| (865) 932-3331 |
| Full Name | Eagles Passage Therapeutic Farm, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2605 Riddle Rd, New Market, Tennessee |
| Authorized Official Name and Position | Lisa Lynn Frady (MEMBER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 8659323331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagles Passage Therapeutic Farm, Llc 2605 Riddle Rd New Market TN 37820-4835 Ph: (865) 932-3331 | Eagles Passage Therapeutic Farm, Llc 2605 Riddle Rd New Market TN 37820-4835 Ph: (865) 932-3331 |
| NPI Number | 1427200757 |
|---|---|
| Provider Enumeration Date | 10/17/2008 |
| Last Update Date | 12/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427200757 | NPI | - | NPPES |
| 264470000 | Other | TN | MAGELLAN |
| 4208400 | Other | TN | BCBST |
| 263470730 | Other | TN | HUMANA-MILITARY |
| 5389124 | Other | TN | AETNA |
| 2088872 | Other | TN | CIGNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LSW0000004526 (Tennessee) | Primary |
Nikki Ohartz Lcsw Counseling Services Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 980 W Highway 11e, New Market, TN 37820 Phone: 865-978-2135 |