Provider Demographics
NPI:1063992600
Name:SPRINGS OF LIFE
Entity type:Organization
Organization Name:SPRINGS OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:JAMISON
Authorized Official - Last Name:BRANAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-406-4018
Mailing Address - Street 1:P.O. BOX 893
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762
Mailing Address - Country:US
Mailing Address - Phone:606-304-5395
Mailing Address - Fax:
Practice Address - Street 1:185 BAKER STREET
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762
Practice Address - Country:US
Practice Address - Phone:606-304-5395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP2701X, 103TR0400X
TN1000000022735101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty