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General NPI Number Information
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NPI Number | 1295504660
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN PSYCHIATRY SPECIALISTS, LLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 2202 AWARD WINNING WAY STE 103
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City | KNOXVILLE
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State | TN
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Zip | 37932-1991
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Country | US
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Telephone | 865-432-1521
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Fax | 865-409-5763
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Provider Business Mailing Address
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Address Line | 2202 AWARD WINNING WAY STE 103
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City | KNOXVILLE
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State | TN
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Zip | 37932-1991
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Country | US
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Telephone | 865-432-1521
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Fax | 865-409-5763
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | ELIZABETH AULT
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Credential | MD
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Telephone | 865-432-1521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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