Provider Demographics
NPI: | 1326269119 |
---|---|
Name: | ADVANCED THERAPY SOLUTIONS |
Entity type: | Organization |
Organization Name: | ADVANCED THERAPY SOLUTIONS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CO OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | JOHNSON |
Authorized Official - Last Name: | LINGG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 931-542-2168 |
Mailing Address - Street 1: | 851 PROFESSIONAL PARK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CLARKSVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37040-5257 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 931-542-2168 |
Mailing Address - Fax: | 931-542-2206 |
Practice Address - Street 1: | 851 PROFESSIONAL PARK DR |
Practice Address - Street 2: | |
Practice Address - City: | CLARKSVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37040-5257 |
Practice Address - Country: | US |
Practice Address - Phone: | 931-542-2168 |
Practice Address - Fax: | 931-542-2206 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-01 |
Last Update Date: | 2022-05-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 101YM0800X, 101YP2500X, 103K00000X, 106H00000X, 106S00000X, 2251P0200X, 225200000X, 225XP0200X, 261QM0801X, 261QP2000X | ||
TN | 1041C0700X | |
TN | SP0000001494 | 235Z00000X |
TN | 20795 | 261QM0801X |
TN | I000000020795 | 261QM0801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 4152748 | Other | BCBS |
TN | 5441491 | Medicaid |