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Organization

COUNTRY ESCAPE THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TERRI LYNN CRUM LMT (OWNER)
(931) 622-7243
Entity
Organization

Contact information

Practice address
501 FLATWOOD RD, NEW JOHNSONVILLE, TN 37134-2159
(931) 622-7243
Mailing address
501 FLATWOOD RD, NEW JOHNSONVILLE, TN 37134-2159
(931) 622-7243

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
6490
TN

Other

Enumeration date
12/28/2015
Last updated
01/12/2016
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