Provider Demographics
NPI:1679600720
Name:MENTAL HEALTH COOPERATIVE
Entity type:Organization
Organization Name:MENTAL HEALTH COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DESIRIE
Authorized Official - Last Name:VESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-744-7429
Mailing Address - Street 1:116 BLACKSTONE PL APT B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5401
Mailing Address - Country:US
Mailing Address - Phone:615-744-7429
Mailing Address - Fax:
Practice Address - Street 1:116 BLACKSTONE PL APT B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-5401
Practice Address - Country:US
Practice Address - Phone:615-744-7429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management