Healthcare Provider Details

I. General information

NPI: 1568484095
Provider Name (Legal Business Name): MVP BEHAVIORAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 KINGSTON PIKE
KNOXVILLE TN
37919
US

IV. Provider business mailing address

PO BOX 6166
MARYVILLE TN
37802-6166
US

V. Phone/Fax

Practice location:
  • Phone: 865-809-7640
  • Fax: 931-762-6532
Mailing address:
  • Phone: 865-809-7640
  • Fax: 931-762-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000002574
License Number StateTN

VIII. Authorized Official

Name: ADAM V MCLAIN
Title or Position: OWNER PARTNER/PSYD
Credential: PSYD
Phone: 865-809-7640