Provider Demographics
NPI:1174107965
Name:EMOTIONAL AND BEHAVIORAL THERAPY
Entity type:Organization
Organization Name:EMOTIONAL AND BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:865-280-2123
Mailing Address - Street 1:915 EAGLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-2418
Mailing Address - Country:US
Mailing Address - Phone:865-280-2123
Mailing Address - Fax:561-634-2874
Practice Address - Street 1:915 EAGLE VIEW DR
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-2418
Practice Address - Country:US
Practice Address - Phone:865-280-2123
Practice Address - Fax:561-634-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty