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General NPI Number Information
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NPI Number | 1548430333
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL & COUNSELING SERVICES
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 601 CHARLES ST
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City | MARYVILLE
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State | TN
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Zip | 37804-5048
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Country | US
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Telephone | 865-977-7593
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Fax | 865-977-7598
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Provider Business Mailing Address
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Address Line | 601 CHARLES ST
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City | MARYVILLE
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State | TN
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Zip | 37804-5048
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Country | US
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Telephone | 865-977-7593
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Fax | 865-977-7598
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. KARAN E GOINS
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Credential | LCSW
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Telephone | 865-977-7593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | L 214-107-2118
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License Number State | TN
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