NPIMap

Organization Active NPI

Bearden Psychological & Wellness Center, PLLC

  • Clinical Psychologist
  • Knoxville, TN
National Provider Identifier
1942568019
Registry record updated Apr 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
P2498 Issued in TN
Legal business name
BEARDEN PSYCHOLOGICAL & WELLNESS CENTER, PLLC
Practice address
813 S Northshore Dr
Suite 105
Knoxville, TN 37919-7594
Phone
(865) 584-4005
Fax
(865) 584-5551
NPI assigned
Apr 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2012

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

Authorized official

Name
Dr. K. Shannon Wilson, PH.D.
Title
President
Phone
(865) 584-4005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X P2498 TN Primary

Addresses

Primary practice location

813 S Northshore Dr
Suite 105
Knoxville, TN 37919-7594

Mailing address

PO Box 10372
Knoxville, TN 37939-0372
Phone (865) 584-4005

National Provider Directory

National Provider Directory
Tax ID family
Bearden Psychological and Wellness Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1335398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335398400000",
    "number": "1942568019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10372",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379390372",
            "telephone_number": "865-584-4005",
            "fax_number": "865-584-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 S NORTHSHORE DR",
            "address_2": "SUITE 105",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379197594",
            "telephone_number": "865-584-4005",
            "fax_number": "865-584-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEARDEN PSYCHOLOGICAL & WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-26",
        "last_updated": "2012-04-26",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "K. SHANNON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "865-584-4005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P2498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.