Healthcare Provider Details

I. General information

NPI: 1417893165
Provider Name (Legal Business Name): FOREST PATH THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 BRISTOL HWY STE 304
JOHNSON CITY TN
37601-1556
US

IV. Provider business mailing address

800 HIRAM CLARK RD
ELIZABETHTON TN
37643-1910
US

V. Phone/Fax

Practice location:
  • Phone: 423-719-3253
  • Fax: 423-767-7457
Mailing address:
  • Phone: 423-741-8263
  • Fax: 423-767-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TOMMY SOUTH
Title or Position: OWNER/CLINICAL DIRECTOR/THERAPIST
Credential: LCSW
Phone: 423-719-3253