NPIMap

Organization Active NPI

Mountain States Health Alliance Out-Patient Behavioral Health

  • Health Service Psychologist
  • Kingsport, TN
National Provider Identifier
1083936033
Registry record updated Feb 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service PsychologistTaxonomy code 103TH0100X
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE OUT-PATIENT BEHAVIORAL HEALTH
Practice address
2012 Brookside Dr
Kingsport, TN 37660-4645
Phone
(423) 857-5566
Fax
(423) 857-5564
NPI assigned
Feb 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2010

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

Authorized official

Name
Graciela Pereira
Title
Avp Behavioral Health and Rehab Ser
Phone
(423) 952-1701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TH0100X Primary

Addresses

Primary practice location

2012 Brookside Dr
Kingsport, TN 37660-4645

Mailing address

1021 W Oakland Ave
Suite 207
Johnson City, TN 37604-2191
Phone (423) 952-3104

National Provider Directory

National Provider Directory
Tax ID family
Mountain States Health Alliance41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

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

View all 40

Locations

1021 W Oakland Ave
Ste 207
Johnson City, TN 37604
Phone (423) 915-5116

2012 Brookside Dr
Kingsport, TN 37660
Phone (423) 378-5005

NPI Registry JSON

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1083936033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE",
            "address_2": "SUITE 207",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042191",
            "telephone_number": "423-952-3104",
            "fax_number": "423-952-3109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 BROOKSIDE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604645",
            "telephone_number": "423-857-5566",
            "fax_number": "423-857-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE OUT-PATIENT BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "PEREIRA",
        "authorized_official_first_name": "GRACIELA",
        "authorized_official_title_or_position": "AVP BEHAVIORAL HEALTH AND REHAB SER",
        "authorized_official_telephone_number": "423-952-1701"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; 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.