Provider Demographics
NPI:1467708594
Name:CTR. FOR INDIVID. & FAMILY EFFECTIVENESS
Entity Type:Organization
Organization Name:CTR. FOR INDIVID. & FAMILY EFFECTIVENESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLENNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-265-7935
Mailing Address - Street 1:310 E. 8TH ST.
Mailing Address - Street 2:STE. C
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403
Mailing Address - Country:US
Mailing Address - Phone:423-265-7935
Mailing Address - Fax:423-265-8204
Practice Address - Street 1:2441 BROAD ST.
Practice Address - Street 2:STE. 150
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408
Practice Address - Country:US
Practice Address - Phone:423-265-7935
Practice Address - Fax:423-265-8204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CENTER FOR INDIVIDUAL & FAMILY EFFECTIVENESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000010446251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health