Provider Demographics
NPI:1649023284
Name:CONCORD CHILD AND FAMILY PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:CONCORD CHILD AND FAMILY PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-333-2294
Mailing Address - Street 1:9111 CROSS PARK DR STE D200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4521
Mailing Address - Country:US
Mailing Address - Phone:865-333-2294
Mailing Address - Fax:
Practice Address - Street 1:9111 CROSS PARK DR STE D200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4521
Practice Address - Country:US
Practice Address - Phone:865-333-2294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty