NPIMap

Organization Active NPI

Family Wellness Center of Clarksville, PC

  • Clinical Psychologist
  • Clarksville, TN
National Provider Identifier
1174769277
Registry record updated Dec 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2046 Issued in TN
Legal business name
FAMILY WELLNESS CENTER OF CLARKSVILLE, PC
Practice address
1891 Old Trenton Rd
Clarksville, TN 37040-6734
Phone
(931) 552-4171
Fax
(931) 551-9485
NPI assigned
Dec 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Janice D Martin, PH.D.NPI 1417977802
Title
Ceo
Phone
(931) 552-4171

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 2046 TN Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 1717 TN
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 263 TN
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 611 TN
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 16723 TN

Addresses

Primary practice location

1891 Old Trenton Rd
Clarksville, TN 37040-6734

Mailing address

PO Box 30429
Clarksville, TN 37040-0008
Phone (931) 552-4171

National Provider Directory

National Provider Directory

Locations

1891 Old Trenton Rd
Clarksville, TN 37040
Phone (931) 552-4171

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229731200000",
    "number": "1174769277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30429",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370400008",
            "telephone_number": "931-552-4171",
            "fax_number": "931-551-9485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 OLD TRENTON RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406734",
            "telephone_number": "931-552-4171",
            "fax_number": "931-551-9485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY WELLNESS CENTER OF CLARKSVILLE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-20",
        "last_updated": "2008-12-20",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-552-4171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "2046",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "1717",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "263",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "611",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "16723",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.