Provider Demographics
NPI:1588138200
Name:KAIROS MENTAL HEALTH COOPERATIVE
Entity type:Organization
Organization Name:KAIROS MENTAL HEALTH COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:615-589-1018
Mailing Address - Street 1:3945 STILTON DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-1630
Mailing Address - Country:US
Mailing Address - Phone:615-589-1018
Mailing Address - Fax:
Practice Address - Street 1:1451 ELM HILL PIKE STE 250
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4579
Practice Address - Country:US
Practice Address - Phone:615-613-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty