Provider Demographics
NPI:1104709534
Name:TENNESSEE KETAMINE & WELLNESS PLLC
Entity type:Organization
Organization Name:TENNESSEE KETAMINE & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-213-1084
Mailing Address - Street 1:1909 MALLORY LN STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2843
Mailing Address - Country:US
Mailing Address - Phone:615-813-5006
Mailing Address - Fax:
Practice Address - Street 1:1909 MALLORY LN STE 300
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2843
Practice Address - Country:US
Practice Address - Phone:615-813-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)