Provider Demographics
NPI:1184001869
Name:COMPREHENSIVE PSYCHIATRIC CARE, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHIATRIC CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-708-8670
Mailing Address - Street 1:7161 LEE HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8608
Mailing Address - Country:US
Mailing Address - Phone:423-708-8670
Mailing Address - Fax:423-708-8671
Practice Address - Street 1:7161 LEE HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8608
Practice Address - Country:US
Practice Address - Phone:423-708-8670
Practice Address - Fax:423-708-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47441041C0700X
TN385692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ12667Medicaid
TN3895348Medicaid
TNQ12667Medicaid
TN103G703772Medicare PIN