Provider Demographics
NPI:1942286521
Name:PSYCHIATRIC CONCEPTS, LLC
Entity Type:Organization
Organization Name:PSYCHIATRIC CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:865-591-4703
Mailing Address - Street 1:2620 MINERAL SPRINGS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1569
Mailing Address - Country:US
Mailing Address - Phone:865-591-4703
Mailing Address - Fax:865-288-3303
Practice Address - Street 1:2620 MINERAL SPRINGS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1569
Practice Address - Country:US
Practice Address - Phone:865-591-4703
Practice Address - Fax:865-288-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000077192363LP0808X
TN14934363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373224Medicaid
TN3907658Medicaid
TN3373224Medicaid
TN3373224Medicare ID - Type UnspecifiedGROUP PROVIDER NO
TN3907656Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NO