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NPI Code Detail

MEDICARE: MOUNTAIN YOUTH ACADEMY

MEDICARE: MOUNTAIN YOUTH ACADEMY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment FacilityL237M21261695TN
2322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityL237M21261695TN

General Provider Information

NPI Number : 1083832117
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN YOUTH ACADEMY
Provider Business Mailing Address
First Line : 332 HOSPITAL RD
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-4309
Country : US
Telephone Number : 423-727-9898
Fax Number : 423-727-9899
Provider Business Practice Location Address
First Line : 332 HOSPITAL RD
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-4309
Country : US
Telephone Number : 423-727-9898
Fax Number : 423-727-9899
Authorized Official
Title or Position : THERAPIST
Name : MISS CLARA E. SMITH
Credential : LCSW
Telephone Number : 423-727-9898
Provider Enumeration Date : 04/23/2007
Last Update Date : 09/11/2025

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Directions to “MOUNTAIN YOUTH ACADEMY ” Practice Location

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