1134471709 NPI number — MS. STACEY RENEE BRAUND LMSW

Table of content: MS. STACEY RENEE BRAUND LMSW (NPI 1134471709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134471709 NPI number — MS. STACEY RENEE BRAUND LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAUND
Provider First Name:
STACEY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHRAMEK
Provider Other First Name:
STACEY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134471709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6350 W ANDREW JOHNSON HWY
Provider Second Line Business Mailing Address:
DEPARTMENT 100
Provider Business Mailing Address City Name:
TALBOTT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37877-8605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-355-3565
Provider Business Mailing Address Fax Number:
423-714-2355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 E WATT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALCOA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37701-2236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-273-1616
Provider Business Practice Location Address Fax Number:
865-273-1645
Provider Enumeration Date:
10/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  9593 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)