Healthcare Provider Details

I. General information

NPI: 1619891207
Provider Name (Legal Business Name): TELOS HEALTH SYSTEMS TN PROVIDER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1992 HIGHWAY 51 S
COVINGTON TN
38019-3623
US

IV. Provider business mailing address

980 SYLVAN AVE FL 2
ENGLEWOOD CLIFFS NJ
07632-3320
US

V. Phone/Fax

Practice location:
  • Phone: 201-217-6777
  • Fax:
Mailing address:
  • Phone: 201-217-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PETER BAILEY
Title or Position: CEO
Credential:
Phone: 201-217-6777