Provider Demographics
NPI:1669604823
Name:UNIVERSITY OF TENNESSEE-KNOXVILLE PSYCHOLOGICAL CLINIC
Entity type:Organization
Organization Name:UNIVERSITY OF TENNESSEE-KNOXVILLE PSYCHOLOGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LAURENCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-974-2161
Mailing Address - Street 1:227 AUSTIN PEAY BUILDING UNIVERSITY OF TENN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37996-0001
Mailing Address - Country:US
Mailing Address - Phone:865-974-2161
Mailing Address - Fax:865-584-5932
Practice Address - Street 1:227 AUSTIN PEAY BUILDING UNIVERSITY OF TENN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0001
Practice Address - Country:US
Practice Address - Phone:865-974-2161
Practice Address - Fax:865-584-5932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000004934261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health