Provider Demographics
NPI:1790451649
Name:FORESIGHT VIRTUAL MENTAL HEALTH CARE
Entity Type:Organization
Organization Name:FORESIGHT VIRTUAL MENTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:423-715-7893
Mailing Address - Street 1:PO BOX 1555
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-1555
Mailing Address - Country:US
Mailing Address - Phone:423-715-7893
Mailing Address - Fax:423-295-8984
Practice Address - Street 1:TELEHEALTH
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-715-7893
Practice Address - Fax:423-295-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1760632434OtherNPI