=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962301820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KNOXVILLE BEHAVIORAL WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 MARINE WAY
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37865-5574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-324-0930
-----------------------------------------------------
Fax | 833-535-0164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 MARINE WAY
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37865-5574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-324-0930
-----------------------------------------------------
Fax | 833-535-0164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | JARED TURNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-812-9652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------