1912199167 NPI number — LLOYD C. ELAM MENTAL HEALTH CENTER

Table of content: JOANNA CAASI MACARAEG PSYD (NPI 1578304481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912199167 NPI number — LLOYD C. ELAM MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LLOYD C. ELAM MENTAL HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912199167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 DAVID B. TODD JR. BLVD.
Provider Second Line Business Mailing Address:
LLOYD C. ELAM MENTAL HEALTH CENTER
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 DAVID B. TODD JR. BLVD.
Provider Second Line Business Practice Location Address:
LLOYD C. ELAM MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-327-6255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OKPAKU
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR AND CHAIRMAN
Authorized Official Telephone Number:
615-327-6824

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  0000000324 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 0000000324 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 0000000324 , 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)