Provider Demographics
NPI:1821654583
Name:TRI-CITIES EATING DISORDER THERAPY
Entity Type:Organization
Organization Name:TRI-CITIES EATING DISORDER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHALEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:423-708-6982
Mailing Address - Street 1:2700 S ROAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7557
Mailing Address - Country:US
Mailing Address - Phone:423-708-6982
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST STE 203
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7557
Practice Address - Country:US
Practice Address - Phone:423-708-6982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty