| Organization Name: | TELLICO BAY COUNSELING & WELLNESS CENTER |
| NPI Number: | 1639239791 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHIRLEY AMANDA SEXTON (CEO) |
| Mailing Address: | 104 Dawson St Vonore |
| State: | TN US |
| Postal Code: | 378852416 |
| Phone Number: | 4238842479 |
| Fax Number: | 4238842491 |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC0000001953 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |