Provider Demographics
NPI:1487666806
Name:PSYCHIATRIC SERVICES, INC.
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIN
Authorized Official - Prefix:
Authorized Official - First Name:MANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-235-4943
Mailing Address - Street 1:108 GLENLEIGH CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3038
Mailing Address - Country:US
Mailing Address - Phone:865-675-1480
Mailing Address - Fax:865-675-1485
Practice Address - Street 1:108 GLENLEIGH CT
Practice Address - Street 2:SUITE 2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3038
Practice Address - Country:US
Practice Address - Phone:865-675-1480
Practice Address - Fax:865-675-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27350261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID