Provider Demographics
NPI:1285316711
Name:UMPHREY, CHESSIE LAUREN
Entity type:Individual
Prefix:
First Name:CHESSIE
Middle Name:LAUREN
Last Name:UMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHESSIE
Other - Middle Name:LAUREN
Other - Last Name:UMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:247 W MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3327
Mailing Address - Country:US
Mailing Address - Phone:615-314-3292
Mailing Address - Fax:
Practice Address - Street 1:247 W MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3327
Practice Address - Country:US
Practice Address - Phone:615-314-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician