Provider Demographics
NPI:1881446854
Name:MIGHTY OAK CHRISTIAN MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:MIGHTY OAK CHRISTIAN MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DAWN HIGHSMITH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-MHSP, NCC
Authorized Official - Phone:615-389-5589
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-1086
Mailing Address - Country:US
Mailing Address - Phone:615-389-5589
Mailing Address - Fax:
Practice Address - Street 1:2106 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3937
Practice Address - Country:US
Practice Address - Phone:615-389-5589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty