| NPI | 1336421452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP K. AXTELL Director 865-247-4055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN 2763) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2016-09-13 |