Healthcare Provider Details

I. General information

NPI: 1376180216
Provider Name (Legal Business Name): HIGHLANDS MINDCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MIDWAY ST. SUITE 1
BRISTOL TN
37620
US

IV. Provider business mailing address

28 MIDWAY ST. SUITE 1
BRISTOL TN
37620
US

V. Phone/Fax

Practice location:
  • Phone: 423-764-2165
  • Fax: 423-217-0779
Mailing address:
  • Phone: 423-764-2165
  • Fax: 423-217-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JANE KEITH
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 423-764-2165