James T Berry, PHD
Individual provider Active NPI Psychologist · Knoxville, TN
NPI 1679622005 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679622005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- P2079 (TN)
- Practice address
- 325 Ebenezer Rd
Ebenezer Counseling Services
Knoxville, TN 37923 - Phone
- (465) 670-0988
- Fax
- (865) 670-1991
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P2079 | TN | MD | Professional Counselor |
| 2079 | TN | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ebenezer Counseling Services | Current | Accepting new patients |
Locations
325 Ebenezer Rd
Knoxville, TN 37923
Phone (865) 670-0988
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | P2079 | TN | Yes |
Addresses
Primary practice location
325 Ebenezer Rd
Ebenezer Counseling Services
Knoxville, TN 37923
Mailing address
325 Ebenezer Rd
Ebenezer Counseling Services
Knoxville, TN 37923
Phone (465) 670-0988
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3980497 | Medicaid | TN | |
| 3045949 | Other | TN | BCBS |
Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.