Individual
MARY KATHERINE HANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
207 W BLACKWELL ST, TULLAHOMA, TN 37388-3395
(931) 461-0290
Mailing address
11331 TULLAHOMA HWY, TULLAHOMA, TN 37388-6015
(931) 636-8128
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
621674308
TN
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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