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NPI Code Detail

MEDICARE: AGAPE YOUTH BEHAVIORAL HEALTH

MEDICARE: AGAPE YOUTH BEHAVIORAL HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/Center31714TN

General Provider Information

NPI Number : 1528405925
Entity Type Code : Organization
Provider Name (Legal Business Name) : AGAPE YOUTH BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 1360 MACKEY BRANCH DR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-3225
Country : US
Telephone Number : 423-443-3336
Fax Number : 423-464-7510
Provider Business Practice Location Address
First Line : 1360 MACKEY BRANCH DR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-3225
Country : US
Telephone Number : 423-443-3336
Fax Number : 423-464-7510
Authorized Official
Title or Position : CREDENTIALING
Name : COURTNEY CANTRELL
Credential :
Telephone Number : 423-443-3336
Provider Enumeration Date : 05/27/2013
Last Update Date : 02/07/2023

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Directions to “AGAPE YOUTH BEHAVIORAL HEALTH ” Practice Location

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