| Psychotherapy And Forensic Services | |
|
519 W Lamar Alexander Pkwy Maryville TN 37801-4701 | |
| (865) 309-5427 | |
| (866) 318-9025 |
| Full Name | Psychotherapy And Forensic Services |
|---|---|
| Speciality | Counselor |
| Location | 519 W Lamar Alexander Pkwy, Maryville, Tennessee |
| Authorized Official Name and Position | Kim Judkins (PRACTICE ADMIN/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8655792694 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapy And Forensic Services Po Box 5568 Maryville TN 37802-5568 Ph: (865) 309-5427 | Psychotherapy And Forensic Services 519 W Lamar Alexander Pkwy Maryville TN 37801-4701 Ph: (865) 309-5427 |
| NPI Number | 1306315734 |
|---|---|
| Provider Enumeration Date | 11/14/2018 |
| Last Update Date | 08/10/2021 |
| Certification Date | 08/10/2021 |
| Medicare PECOS PAC ID | 7315337995 |
|---|---|
| Medicare Enrollment ID | O20211214002578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306315734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Shannon W Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033302674 PECOS PAC ID: 8325298920 Enrollment ID: I20121017000022 |
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