Doctor Name: | MARY KATHERINE HANE |
NPI Number: | 1144623620 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 621674308 |
Business Practice Address: | 207 W Blackwell St Tullahoma, TN - 373883395 |
Business Phone Number: | 9314610290 |
Business Fax Number: | |
Mailing Address: | 11331 Tullahoma Hwy, TULLAHOMA |
State: | TN |
Postal Code: | 373886015 |
Phone Number: | 9316368128 |
Fax Number: | |
NPI Enumeration Date: | 09/29/2014 |
NPI Last Update Date: | 09/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 621674308 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |