# PSYCHOTHERAPY AND FORENSIC SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306315734
- **Authorized official:** KIM JUDKINS (PRACTICE ADMIN/AUTHORIZED OFFICIAL)
- **Authorized official phone:** (865) 579-2694

## Contact information

- **Practice address:** 519 W LAMAR ALEXANDER PKWY, MARYVILLE, TN 37801-4701
- **Practice address phone:** (865) 309-5427
- **Practice address fax:** (866) 318-9025
- **Mailing address:** PO BOX 5568, MARYVILLE, TN 37802-5568
- **Mailing address phone:** (865) 309-5427
- **Mailing address fax:** (866) 318-9025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |

## Other

- **Enumeration date:** 11/14/2018
- **Last updated:** 08/10/2021