Provider Demographics
NPI:1992294102
Name:IMANI BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:IMANI BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-669-8372
Mailing Address - Street 1:93 BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3217
Mailing Address - Country:US
Mailing Address - Phone:931-919-2686
Mailing Address - Fax:
Practice Address - Street 1:93 BEAUMONT ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3217
Practice Address - Country:US
Practice Address - Phone:931-919-2686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty