MEDICARE: TENNESSEE KETAMINE & THERAPEUTICS

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1427844653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE KETAMINE & THERAPEUTICS

Provider Business Mailing Address
First Line	:	718 W LAMAR ALEXANDER PKWY
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37801-3943
Country	:	US
Telephone Number	:	865-304-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 W LAMAR ALEXANDER PKWY
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37801-3943
Country	:	US
Telephone Number	:	865-233-6188
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EMMA ROTHERY
Credential	:
Telephone Number	:	865-304-9622

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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Directions to “TENNESSEE KETAMINE & THERAPEUTICS ” Practice Location

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