Provider Demographics
NPI:1083632897
Name:MENTAL HEALTH COOPERATIVE, INC
Entity type:Organization
Organization Name:MENTAL HEALTH COOPERATIVE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-743-1402
Mailing Address - Street 1:275 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1803
Mailing Address - Country:US
Mailing Address - Phone:615-726-3340
Mailing Address - Fax:
Practice Address - Street 1:275 CUMBERLAND BND
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1803
Practice Address - Country:US
Practice Address - Phone:615-726-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL2140563195261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704488Medicare ID - Type UnspecifiedMEDICARE NUMBER