Provider Demographics
NPI:1811873300
Name:MANTOOTH, MISTY D
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:MANTOOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 DEER RUN TRCE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2274
Mailing Address - Country:US
Mailing Address - Phone:706-957-3558
Mailing Address - Fax:
Practice Address - Street 1:LIFESTANCE THERAPISTS & PSYCHIATRISTS BRENTWOOD
Practice Address - Street 2:9020 OVERLOOK BLVD SUITE 130
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-905-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN180015104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker