Provider Demographics
NPI:1104364504
Name:BARAJAS, NICHOLAUS TJ
Entity Type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:TJ
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 DODSON AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-7015
Mailing Address - Country:US
Mailing Address - Phone:865-394-5148
Mailing Address - Fax:
Practice Address - Street 1:3105 ESSARY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2409
Practice Address - Country:US
Practice Address - Phone:865-687-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health