Healthcare Provider Details

I. General information

NPI: 1639763493
Provider Name (Legal Business Name): BRIANNA JOYCE GWATHNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 LAKE BROOK BLVD
KNOXVILLE TN
37909-1137
US

IV. Provider business mailing address

200 TECH CENTER DR
KNOXVILLE TN
37912-2747
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-9711
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC019169
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11337
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: