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General NPI Number Information
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NPI Number | 1306315734
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY AND FORENSIC SERVICES
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 519 W LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37801-4701
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Country | US
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Telephone | 865-309-5427
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Fax | 866-318-9025
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Provider Business Mailing Address
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Address Line | PO BOX 5568
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City | MARYVILLE
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State | TN
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Zip | 37802-5568
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Country | US
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Telephone | 865-309-5427
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Fax | 866-318-9025
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Authorized Official
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Title or Position | PRACTICE ADMIN/AUTHORIZED OFFICIAL
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Name | KIM JUDKINS
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Credential |
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Telephone | 865-579-2694
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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 | 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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