Provider Demographics
NPI:1972702223
Name:GAYLE M CRAVENS
Entity type:Organization
Organization Name:GAYLE M CRAVENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CRAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DR,LPC,LMFT
Authorized Official - Phone:731-608-3977
Mailing Address - Street 1:367B N PARKWAY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2899
Mailing Address - Country:US
Mailing Address - Phone:731-668-2277
Mailing Address - Fax:731-660-0510
Practice Address - Street 1:367B N PARKWAY STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2899
Practice Address - Country:US
Practice Address - Phone:731-668-2277
Practice Address - Fax:731-660-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty