| Positive Living Group | |
|
39 Murray Guard Dr Jackson TN 38305-3610 | |
| (731) 267-2861 | |
| (877) 334-9483 |
| Full Name | Positive Living Group |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 39 Murray Guard Dr, Jackson, Tennessee |
| Authorized Official Name and Position | Raymond Watt (MANAGING MEMBER) |
| Authorized Official Contact | 7312672861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Living Group 40 Crest Ridge Dr Jackson TN 38305-8502 Ph: (731) 267-2861 | Positive Living Group 39 Murray Guard Dr Jackson TN 38305-3610 Ph: (731) 267-2861 |
| NPI Number | 1336614130 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Medicare PECOS PAC ID | 8224367370 |
|---|---|
| Medicare Enrollment ID | O20190916000575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336614130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Tasma Graham Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003194044 PECOS PAC ID: 3072787886 Enrollment ID: I20111114000063 |
| Provider Name | Twana C Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912248212 PECOS PAC ID: 2769623370 Enrollment ID: I20130724000558 |
| Provider Name | Kenneth Perry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922770528 PECOS PAC ID: 4789029273 Enrollment ID: I20240223001864 |
| Provider Name | Jessica Harrison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285362889 PECOS PAC ID: 9638518848 Enrollment ID: I20240422001125 |
| Provider Name | Anika Powell Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114622560 PECOS PAC ID: 1254771371 Enrollment ID: I20240506003384 |
| Provider Name | Giavante Douglas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992490122 PECOS PAC ID: 9830539923 Enrollment ID: I20240507001490 |
| Provider Name | Glen Gaugh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003321902 PECOS PAC ID: 9436590502 Enrollment ID: I20240508000278 |
| Provider Name | Yulanda Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427764265 PECOS PAC ID: 2567803588 Enrollment ID: I20240508002199 |
| Provider Name | Teresa Easton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689082018 PECOS PAC ID: 5799126629 Enrollment ID: I20240509002634 |
| Provider Name | Lequite Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407988538 PECOS PAC ID: 8729429410 Enrollment ID: I20240513001516 |
| Provider Name | Alyssa Lytle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245979665 PECOS PAC ID: 9133661879 Enrollment ID: I20240610000537 |
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Advanced Psychiatric Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 50 Bent Creek Ln, Jackson, TN 38305 Phone: 731-668-6566 Fax: 731-660-8739 |