| Phoenix Fire Aba | |
|
456 Pond Apple Rd Unit 37 Clarksville TN 37043-5357 | |
| (301) 752-6997 | |
| (931) 218-2075 |
| Full Name | Phoenix Fire Aba |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 456 Pond Apple Rd Unit 37, Clarksville, Tennessee |
| Authorized Official Name and Position | Fleur Whitehead (ADMIN SUPERVISOR) |
| Authorized Official Contact | 9315727402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Fire Aba 456 Pond Apple Rd Unit 37 Clarksville TN 37043-5357 Ph: (301) 752-6997 | Phoenix Fire Aba 456 Pond Apple Rd Unit 37 Clarksville TN 37043-5357 Ph: (301) 752-6997 |
| NPI Number | 1124737283 |
|---|---|
| Provider Enumeration Date | 11/17/2022 |
| Last Update Date | 11/17/2022 |
| Certification Date | 11/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124737283 | NPI | - | NPPES |
| Q052735 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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