Provider Demographics
NPI:1740959683
Name:MENDING HEARTS WELLNESS CENTER OF TENNESSEE LLC
Entity type:Organization
Organization Name:MENDING HEARTS WELLNESS CENTER OF TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:865-579-6756
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-1205
Mailing Address - Country:US
Mailing Address - Phone:865-484-9355
Mailing Address - Fax:865-484-9899
Practice Address - Street 1:854 HIGHWAY 92 S STE B
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4969
Practice Address - Country:US
Practice Address - Phone:865-484-9355
Practice Address - Fax:865-484-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty