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General NPI Number Information
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NPI Number | 1740959683
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Entity Type | Organization
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Legal Business Name | MENDING HEARTS WELLNESS CENTER OF TENNESSEE LLC
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 854 HIGHWAY 92 S STE B
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City | DANDRIDGE
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State | TN
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Zip | 37725-4969
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Country | US
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Telephone | 865-484-9355
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Fax | 865-484-9899
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Provider Business Mailing Address
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Address Line | PO BOX 1205
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City | DANDRIDGE
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State | TN
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Zip | 37725-1205
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Country | US
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Telephone | 865-484-9355
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Fax | 865-484-9899
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTI D BANKS
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Credential | APN
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Telephone | 865-579-6756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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