Provider Demographics
NPI:1306614466
Name:NEURO INSTITUTE OF EAST TENNESSEE, PLLC
Entity type:Organization
Organization Name:NEURO INSTITUTE OF EAST TENNESSEE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:865-556-0537
Mailing Address - Street 1:437 HIGHLAND HILLS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4211
Mailing Address - Country:US
Mailing Address - Phone:865-556-0537
Mailing Address - Fax:
Practice Address - Street 1:409 MONTBROOK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2704
Practice Address - Country:US
Practice Address - Phone:865-556-0537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty