Organization Active NPI

Papillon Behavioral Health, LLC

  • Psychologist
  • Johnson City, TN
National Provider Identifier
1043728405
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
P0000003473 Issued in TN
Legal business name
PAPILLON BEHAVIORAL HEALTH, LLC
Practice address
2514 1/2 Wesley St Ste 2
Johnson City, TN 37601
Phone
(423) 529-0385
Fax
(423) 414-2699
NPI assigned
Jan 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nicholas Porta, PSYD
Title
Owner
Phone
(423) 529-0385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X P0000003473 TN Primary

Addresses

Primary practice location

2514 1/2 Wesley St Ste 2
Johnson City, TN 37601

Mailing address

2514 1/2 Wesley St Ste 2
Johnson City, TN 37601-1754
Phone (423) 529-0385

National Provider Directory

National Provider Directory

Locations

2514 Wesley St
Ste 2
Johnson City, TN 37601
Phone (321) 441-6109

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1043728405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 1/2 WESLEY ST STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011754",
            "telephone_number": "423-529-0385",
            "fax_number": "423-414-2699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2514 1/2 WESLEY ST STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-529-0385",
            "fax_number": "423-414-2699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAPILLON BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "PORTA",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-529-0385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P0000003473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.