Organization
PSYCHOTHERAPY AND FORENSIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM JUDKINS (PRACTICE ADMIN/AUTHORIZED OFFICIAL)
(865) 579-2694
Entity
Organization
Contact information
Practice address
519 W LAMAR ALEXANDER PKWY, MARYVILLE, TN 37801-4701
(865) 309-5427
(866) 318-9025
Mailing address
PO BOX 5568, MARYVILLE, TN 37802-5568
(865) 309-5427
(866) 318-9025
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
11/14/2018
Last updated
08/10/2021
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