=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073223095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAUTY FROM ASHES COACHING, COUNSELING, AND CONSULTATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2022
-----------------------------------------------------
Last Update Date | 11/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 FOOTHILLS MALL DRIVE
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37801-3780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-263-6471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 257 N CALDERWOOD ST # 239
-----------------------------------------------------
City | ALCOA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37701-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-263-6471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATRISE THOMPSON
-----------------------------------------------------
Credential | M.ED
-----------------------------------------------------
Telephone | 865-263-6471
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------