Healthcare Provider Details

I. General information

NPI: 1073674552
Provider Name (Legal Business Name): BEHAVIORAL MEDICINE INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/16/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 KINGSTON PIKE STE 250
KNOXVILLE TN
37919-3331
US

IV. Provider business mailing address

2607 KINGSTON PIKE STE 250
KNOXVILLE TN
37919-3331
US

V. Phone/Fax

Practice location:
  • Phone: 865-264-2400
  • Fax: 865-588-6406
Mailing address:
  • Phone: 865-264-2400
  • Fax: 865-588-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP1818
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP2497
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0873
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW673
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW1229
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP1235
License Number StateTN

VIII. Authorized Official

Name: C KEITH HULSE
Title or Position: CEO/PRESIDENT
Credential: PH.D.
Phone: 865-264-2400