Provider Demographics
NPI:1861753105
Name:CLARKSVILLE FAMILY THERAPY
Entity type:Organization
Organization Name:CLARKSVILLE FAMILY THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:931-820-1021
Mailing Address - Street 1:2535 MADISON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3920
Mailing Address - Country:US
Mailing Address - Phone:931-820-1021
Mailing Address - Fax:931-820-1031
Practice Address - Street 1:2535 MADISON ST
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-3920
Practice Address - Country:US
Practice Address - Phone:931-820-1021
Practice Address - Fax:931-820-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5611251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health