1699875112 NPI number — PARENT-CHILD SERVICES GROUP, INC.

Table of content: HECTOR ALBERTO GONZALEZ MS, ATC (NPI 1669936209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699875112 NPI number — PARENT-CHILD SERVICES GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARENT-CHILD SERVICES GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LYNNE HARMON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699875112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1536 WHITOWER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-8843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-567-1928
Provider Business Mailing Address Fax Number:
865-584-6607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1536 WHITOWER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-8843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-567-1928
Provider Business Practice Location Address Fax Number:
865-584-6607
Provider Enumeration Date:
09/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARMON
Authorized Official First Name:
LYNNE
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT/SPEECH-LANG. PATHOLOGIST
Authorized Official Telephone Number:
865-567-1928

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP490 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5440996 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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