Organization
MID SOUTH PSYCH SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JANE ALLEN PMHNP-BC (OWNER)
(731) 609-6096
Entity
Organization
Contact information
Practice address
206 STEVENS RD, BOLIVAR, TN 38008-1120
(731) 609-6096
(865) 246-2106
Mailing address
PO BOX 5777, MARYVILLE, TN 37802-5777
(865) 246-2104
(865) 246-2106
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/29/2018
Last updated
06/29/2018
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