Organization
EAGLES PASSAGE THERAPEUTIC FARM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA LYNN FRADY LCSW (MEMBER/CLINICAL DIRECTOR)
(865) 932-3331
Entity
Organization
Contact information
Practice address
2605 RIDDLE RD, NEW MARKET, TN 37820-4835
(865) 932-3331
(865) 932-3331
Mailing address
2605 RIDDLE RD, NEW MARKET, TN 37820-4835
(865) 932-3331
(865) 932-3331
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000004526
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2088872
CIGNA
TN
01
—
263470730
HUMANA-MILITARY
TN
01
—
264470000
MAGELLAN
TN
01
—
4208400
BCBST
TN
01
—
5389124
AETNA
TN
Enumeration date
10/17/2008
Last updated
12/09/2010
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