=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568484095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MVP BEHAVIORAL CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8350 KINGSTON PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-809-7640
-----------------------------------------------------
Fax | 931-762-6532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6166
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37802-6166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-809-7640
-----------------------------------------------------
Fax | 931-762-6532
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PARTNER/PSYD
-----------------------------------------------------
Name | ADAM V MCLAIN
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 865-809-7640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | P0000002574
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------