Provider Demographics
NPI:1538750286
Name:T4T
Entity type:Organization
Organization Name:T4T
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIFFIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:815-354-7442
Mailing Address - Street 1:38 SJ HICKERSON RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-9262
Mailing Address - Country:US
Mailing Address - Phone:815-354-7442
Mailing Address - Fax:
Practice Address - Street 1:104 W COURT AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2102
Practice Address - Country:US
Practice Address - Phone:833-835-3436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility