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1680 S Jefferson Ave Suite A Cookeville TN 38506-2526 | |
| (931) 854-1605 | |
| (931) 854-1613 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1680 S Jefferson Ave, Cookeville, Tennessee |
| Authorized Official Name and Position | Kimberly Wayne Monks (PRESIDENT) |
| Authorized Official Contact | 9318541605 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1680 S Jefferson Ave Suite A Cookeville TN 38506-2526 Ph: (931) 854-1605 | 1680 S Jefferson Ave Suite A Cookeville TN 38506-2526 Ph: (931) 854-1605 |
| NPI Number | 1497056253 |
|---|---|
| Provider Enumeration Date | 11/10/2010 |
| Last Update Date | 11/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497056253 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | I000000007161 (Tennessee) | Primary |
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