Organization Active NPI

Frontier Health

Doing business as Holston Counseling Center

  • Community/Behavioral Health Agency
  • Kingsport, TN
National Provider Identifier
1700940251
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
L 214-076-1418 Issued in TN
Legal business name
FRONTIER HEALTH
Doing business as
Holston Counseling Center
Practice address
1570 Waverly Rd
Kingsport, TN 37664-2523
Phone
(423) 224-1300
Fax
(423) 224-1375
NPI assigned
Dec 20, 2006
Last updated
Oct 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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

Authorized official

Name
Ms. Teresa M Kidd, PHDNPI 1386656403
Title
President and Ceo
Phone
(423) 467-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X L 214-076-1418 TN
Adult Mental Health Clinic/Center 261QM0850X L 214-076-1418 TN
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 364 TN
Community/Behavioral Health Agency 251S00000X L 214-076-1418 TN Primary

Addresses

Primary practice location

1570 Waverly Rd
Kingsport, TN 37664-2523

Mailing address

PO Box 9054
Gray, TN 37615-9054
Phone (423) 467-3600

Other identifiers 2

IdentifierTypeStateIssuer
SAME AS MEDICARE #SMedicaidTN
49-4916-1MedicaidTN

Other names 1

  • Holston Counseling Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040109000560 TN Part B Supplier - Clinic/Group Practice 2860302320 Receives reassigned benefits from 124 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bristol, TN; Sneedville, TN; Rogersville, TN; Mountain City, TN; Kingsport, TN; Johnson City, TN; Greeneville, TN; Gray, TN…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Frontier Health62 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

218 N Main Ave
Erwin, TN 37650
Phone (423) 741-8263

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": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1700940251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9054",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376159054",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 WAVERLY RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376642523",
            "telephone_number": "423-224-1300",
            "fax_number": "423-224-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONTIER HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2018-10-04",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "423-467-3600",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "TN",
            "license": "L 214-076-1418",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "TN",
            "license": "L 214-076-1418",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "TN",
            "license": "364",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TN",
            "license": "L 214-076-1418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SAME AS MEDICARE #S",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49-4916-1",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holston Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Holston Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.