Healthcare Provider Details

I. General information

NPI: 1487666806
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GLENLEIGH CT SUITE 2
KNOXVILLE TN
37934-3038
US

IV. Provider business mailing address

108 GLENLEIGH CT SUITE 2
KNOXVILLE TN
37934-3038
US

V. Phone/Fax

Practice location:
  • Phone: 865-675-1480
  • Fax: 865-675-1485
Mailing address:
  • Phone: 865-675-1480
  • Fax: 865-675-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number27350
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number27350
License Number StateTN

VIII. Authorized Official

Name: MANJU KHANNA
Title or Position: PHYSICAIN
Credential: MD
Phone: 865-235-4943