Healthcare Provider Details

I. General information

NPI: 1003744962
Provider Name (Legal Business Name): EXPANSIVE LOVE INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 CHEESKOGILI WAY
LOUDON TN
37774-2523
US

IV. Provider business mailing address

156 CHEESKOGILI WAY
LOUDON TN
37774-2523
US

V. Phone/Fax

Practice location:
  • Phone: 865-299-1658
  • Fax:
Mailing address:
  • Phone: 865-299-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY LEE
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYD, LPC-MHSP
Phone: 865-299-1658