Provider Demographics
NPI:1235773748
Name:COUNSELING AND FORENSIC SERVICES
Entity Type:Organization
Organization Name:COUNSELING AND FORENSIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:LYLE-JOINER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:865-816-3166
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-0025
Mailing Address - Country:US
Mailing Address - Phone:865-816-3166
Mailing Address - Fax:865-225-9687
Practice Address - Street 1:481 LEEPER PKWY STE 6&7
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6174
Practice Address - Country:US
Practice Address - Phone:865-816-3166
Practice Address - Fax:865-225-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQOO3573Medicaid