Organization
GARY BROWN
Active
Other names
CHILDREN'S TREATMENT CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KAY PAGE (CREDENTIALING MANAGER)
(731) 693-3465
Entity
Organization
Contact information
Practice address
302 BROADWAY ST, MARTIN, TN 38237-2455
(731) 587-0600
(731) 587-0600
Mailing address
302 BROADWAY ST, MARTIN, TN 38237-2455
(731) 587-0600
(731) 587-0600
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q032646
—
TN
Enumeration date
02/02/2019
Last updated
02/02/2019
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