NPIMap

Organization Active NPI

Etsu Behavioral Health and Wellness Clinic

  • Community/Behavioral Health Agency
  • Johnson City, TN
National Provider Identifier
1073872776
Registry record updated May 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
9378 Issued in TN
Legal business name
ETSU BEHAVIORAL HEALTH AND WELLNESS CLINIC
Practice address
807 University Pkwy
139 Lucille Clement Hall
Johnson City, TN 37614-6500
Phone
(423) 439-7777
Fax
(423) 439-7780
NPI assigned
May 15, 2012
Last updated
May 15, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST TENNESSEE STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2012

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

Authorized official

Name
Dr. Kerry L. Holland, PH.D.NPI 1811960644
Title
Clinic Director
Phone
(423) 439-7777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 9378 TN Primary

Addresses

Primary practice location

807 University Pkwy
139 Lucille Clement Hall
Johnson City, TN 37614-6500

Mailing address

807 University Parkway, Campus Box 70416
139 Lucille Clement Hall
Johnson City, TN 37614
Phone (423) 439-7777

National Provider Directory

National Provider Directory
Tax ID family
Etsu Behavioral Health and Wellness Clinic20 organizations share this tax ID, including this one
Part of
Etsu Behavioral Health and Wellness Clinic

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337040000000",
    "number": "1073872776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PARKWAY, CAMPUS BOX 70416",
            "address_2": "139 LUCILLE CLEMENT HALL",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37614",
            "telephone_number": "423-439-7777",
            "fax_number": "423-439-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PKWY",
            "address_2": "139 LUCILLE CLEMENT HALL",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376146500",
            "telephone_number": "423-439-7777",
            "fax_number": "423-439-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETSU BEHAVIORAL HEALTH AND WELLNESS CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TENNESSEE STATE UNIVERSITY",
        "enumeration_date": "2012-05-15",
        "last_updated": "2012-05-15",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "423-439-7777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TN",
            "license": "9378",
            "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 May 15, 2012; 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.