Healthcare Provider Details

I. General information

NPI: 1053558510
Provider Name (Legal Business Name): LOVE-HOPE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3826 TIBERIUS RD STE 315
KNOXVILLE TN
37918
US

IV. Provider business mailing address

3826 TIBERIUS RD STE 315
KNOXVILLE TN
37918-6922
US

V. Phone/Fax

Practice location:
  • Phone: 865-824-6185
  • Fax:
Mailing address:
  • Phone: 865-824-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2845330
License Number StateTN

VIII. Authorized Official

Name: MR. REUBEN MITCHELL
Title or Position: PASTOR
Credential:
Phone: 865-824-6185