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Organization
FRONTIER HEALTH
Active
Organization
FRONTIER HEALTH
Active
Other names
Nolachuckey -Holston Area Mental Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA M KIDD PHD (PRESIDENT AND CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
401 HOLSTON DR, GREENEVILLE, TN 37743-3127
(423) 639-1104
(423) 636-8365
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
L 214-076-1423
TN
251S00000X
Community/Behavioral Health Agency
L 241-076-1423
TN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
L 214-076-1423
TN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
368
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49-4918-8
—
VA
05
—
SAME AS MEDICARE #S
—
TN
Enumeration date
12/27/2006
Last updated
10/04/2018
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