Organization
SPRINGS OF LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLIFF JAMISON BRANAM (DIRECTOR)
(865) 406-4018
Entity
Organization
Contact information
Practice address
185 BAKER STREET, JELLICO, TN 37762
(606) 304-5395
Mailing address
P.O. BOX 893, JELLICO, TN 37762
(606) 304-5395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1000000022735
TN
103TP2701X
Group Psychotherapy Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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