Individual
KEVIN CLARK BLANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4006 SUTHERLAND AVE, KNOXVILLE, TN 37919-5103
(865) 584-6111
Mailing address
4006 SUTHERLAND AVE, KNOXVILLE, TN 37919-5103
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
TNP1158
TN
Other
Enumeration date
07/23/2012
Last updated
07/23/2012
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