Provider Demographics
NPI:1902375942
Name:KNOXVILLE MINDFUL WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:KNOXVILLE MINDFUL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GENRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-213-6648
Mailing Address - Street 1:9613 COTESWORTH LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3431
Mailing Address - Country:US
Mailing Address - Phone:501-213-6648
Mailing Address - Fax:865-217-1109
Practice Address - Street 1:10700 VIRGINIA PINE WAY STE 202
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1801
Practice Address - Country:US
Practice Address - Phone:865-407-0071
Practice Address - Fax:865-217-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty