Organization
CLOVER MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN H DONNELLY (CEO/OWNER)
(615) 955-1729
Entity
Organization
Contact information
Practice address
135 QUITA CIR APT B, LEBANON, TN 37087-4440
(615) 955-1729
Mailing address
135 QUITA CIR APT B, LEBANON, TN 37087-4440
(615) 955-1729
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
04/23/2020
Last updated
09/06/2023
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