Healthcare Provider Details

I. General information

NPI: 1265858682
Provider Name (Legal Business Name): TRI-CITIES THERAPY & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 NORTH ROAN STREET SUITE 406
JOHNSON CITY TN
37601
US

IV. Provider business mailing address

1907 N ROAN ST SUITE 406
JOHNSON CITY TN
37601-3164
US

V. Phone/Fax

Practice location:
  • Phone: 423-943-5550
  • Fax:
Mailing address:
  • Phone: 423-943-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2303
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251H1300X
TaxonomyHuman Factors Physical Therapist
License Number9490
License Number StateTN

VIII. Authorized Official

Name: MR. JOSEPH C JOHNSTON II
Title or Position: PRESIDENT
Credential: LICENSED COUNSELOR
Phone: 423-943-5550