Basic Information
Provider Information | |||||||||
NPI: | 1841649027 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEARDEN | ||||||||
FirstName: | HOLLY | ||||||||
MiddleName: | ASHTON | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CROWE | ||||||||
OtherFirstName: | HOLLY | ||||||||
OtherMiddleName: | ASHTON | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 201 W SPRINGDALE AVE | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379175158 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6563797118 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 255 E WATT ST | ||||||||
Address2: |   | ||||||||
City: | ALCOA | ||||||||
State: | TN | ||||||||
PostalCode: | 37701 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8652731616 | ||||||||
FaxNumber: | 8652731645 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2016 | ||||||||
LastUpdateDate: | 06/12/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X |   |   | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 171M00000X |   |   | N |   | Other Service Providers | Case Manager/Care Coordinator |   | 104100000X | LSW11254 | TN | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.