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Organization

FRONTIER HEALTH

Active
Other names
Adventure Program
Organization subpart
No

Provider details

NPI number
Authorized official
CRISTI L BLALOCK MBA (DIRECTOR CONTRACTING/ COMPLIANCE)
(423) 467-3741
Entity
Organization

Contact information

Practice address
210 E WATAUGA AVE, JOHNSON CITY, TN 37601-4630
(423) 232-4326
(423) 232-4255
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644

Taxonomy

Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
315
TN

Other

Enumeration date
12/08/2006
Last updated
07/01/2025
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