Provider Demographics
NPI:1639239791
Name:TELLICO BAY COUNSELING & WELLNESS CENTER
Entity Type:Organization
Organization Name:TELLICO BAY COUNSELING & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MHC, NCC
Authorized Official - Phone:423-884-2479
Mailing Address - Street 1:104 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2416
Mailing Address - Country:US
Mailing Address - Phone:423-884-2479
Mailing Address - Fax:423-884-2491
Practice Address - Street 1:104 DAWSON ST
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2416
Practice Address - Country:US
Practice Address - Phone:423-884-2479
Practice Address - Fax:423-884-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty