| NPI | 1013778034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL LANE Owner And Pmhnp 865-322-1953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-01-17 |