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Organization

MOUNTAIN STATES HEALTH ALLIANCE OUT-PATIENT BEHAVIORAL HEALTH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GRACIELA PEREIRA (AVP BEHAVIORAL HEALTH AND REHAB SER)
(423) 952-1701
Entity
Organization

Contact information

Practice address
2012 BROOKSIDE DR, KINGSPORT, TN 37660-4645
(423) 857-5566
(423) 857-5564
Mailing address
1021 W OAKLAND AVE, SUITE 207, JOHNSON CITY, TN 37604-2191
(423) 952-3104
(423) 952-3109

Taxonomy

Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary

Other

Enumeration date
02/18/2010
Last updated
02/18/2010
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