Provider Demographics
NPI:1306315734
Name:PSYCHOTHERAPY AND FORENSIC SERVICES
Entity type:Organization
Organization Name:PSYCHOTHERAPY AND FORENSIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-579-2694
Mailing Address - Street 1:PO BOX 5568
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5568
Mailing Address - Country:US
Mailing Address - Phone:865-309-5427
Mailing Address - Fax:866-318-9025
Practice Address - Street 1:519 W LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4701
Practice Address - Country:US
Practice Address - Phone:865-309-5427
Practice Address - Fax:866-318-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty