Provider Demographics
NPI:1356617401
Name:CREEKSIDE CENTER FOR DEPRESSION AND TMS
Entity type:Organization
Organization Name:CREEKSIDE CENTER FOR DEPRESSION AND TMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEPPER
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, MHSP
Authorized Official - Phone:731-660-0199
Mailing Address - Street 1:174 MURRAY GUARD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3742
Mailing Address - Country:US
Mailing Address - Phone:731-660-0199
Mailing Address - Fax:731-660-3650
Practice Address - Street 1:174 MURRAY GUARD DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3742
Practice Address - Country:US
Practice Address - Phone:731-660-0199
Practice Address - Fax:731-660-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3683445Medicare PIN