Provider Demographics
NPI:1992253389
Name:VANDERBILT PSYCHIATRIC HOSPITAL
Entity type:Organization
Organization Name:VANDERBILT PSYCHIATRIC HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TOYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MALBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-386-0037
Mailing Address - Street 1:1601 23RD AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3133
Mailing Address - Country:US
Mailing Address - Phone:615-320-7707
Mailing Address - Fax:
Practice Address - Street 1:1601 23RD AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3133
Practice Address - Country:US
Practice Address - Phone:615-320-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital