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General NPI Number Information
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NPI Number | 1003744962
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Entity Type | Organization
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Legal Business Name | EXPANSIVE LOVE INTEGRATIVE HEALTH
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 156 CHEESKOGILI WAY
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City | LOUDON
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State | TN
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Zip | 37774-2523
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Country | US
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Telephone | 865-299-1658
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Fax |
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Provider Business Mailing Address
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Address Line | 156 CHEESKOGILI WAY
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City | LOUDON
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State | TN
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Zip | 37774-2523
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Country | US
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Telephone | 865-299-1658
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. KIMBERLY LEE
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Credential | PSYD, LPC-MHSP
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Telephone | 865-299-1658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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