Provider Demographics
NPI:1972905156
Name:BEARDEN PSYCHOLOGICAL AND WELLNESS CENTER
Entity type:Organization
Organization Name:BEARDEN PSYCHOLOGICAL AND WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCNEW
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:865-584-4005
Mailing Address - Street 1:813 SOUTH NORTHSORE DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-584-4005
Mailing Address - Fax:865-584-5551
Practice Address - Street 1:813 SOUTH NORTHSORE DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-584-4005
Practice Address - Fax:865-584-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)