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General NPI Number Information
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NPI Number | 1417893165
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Entity Type | Organization
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Legal Business Name | FOREST PATH THERAPY GROUP LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 3119 BRISTOL HWY STE 304
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1556
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Country | US
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Telephone | 423-719-3253
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Fax | 423-767-7457
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Provider Business Mailing Address
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Address Line | 800 HIRAM CLARK RD
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City | ELIZABETHTON
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State | TN
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Zip | 37643-1910
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Country | US
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Telephone | 423-741-8263
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Fax | 423-767-7457
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR/THERAPIST
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Name | TOMMY SOUTH
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Credential | LCSW
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Telephone | 423-719-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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