=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548588312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN YANTIS LPC-MHSP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2010
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 DOWELL SPRINGS BLVD STE 330
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37909-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-371-8573
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3606 W ANDREW JOHNSON HWY
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-378-6929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 7601
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------