Provider Demographics
NPI:1073674552
Name:BEHAVIORAL MEDICINE INSTITUTE PC
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HULSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-264-2400
Mailing Address - Street 1:2607 KINGSTON PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3331
Mailing Address - Country:US
Mailing Address - Phone:865-264-2400
Mailing Address - Fax:865-588-6406
Practice Address - Street 1:2607 KINGSTON PIKE STE 250
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3331
Practice Address - Country:US
Practice Address - Phone:865-264-2400
Practice Address - Fax:865-588-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1818103TC0700X
TNP2497103TC0700X
TNP0873103TC0700X
TNLSW6731041C0700X
TNLSW12291041C0700X
TNP1235103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3681783Medicare ID - Type UnspecifiedMEDICARE
TN3693681Medicare ID - Type UnspecifiedMEDICARE
TN3694892Medicare ID - Type UnspecifiedMEDICARE
TN3582445Medicare ID - Type Unspecified
TN3983173Medicare ID - Type UnspecifiedMEDICARE
TN3685221Medicare ID - Type UnspecifiedMEDICARE