Provider Demographics
NPI:1194555904
Name:STAGGS, ELLEN JACEY
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JACEY
Last Name:STAGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 CENTRAL PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6101
Mailing Address - Country:US
Mailing Address - Phone:615-881-2087
Mailing Address - Fax:
Practice Address - Street 1:4731 TROUSDALE DR STE 10
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1311
Practice Address - Country:US
Practice Address - Phone:615-832-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician