MEDICARE: MRS. ELIZABETH DARLENE GEARHART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1154661049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH DARLENE GEARHART

Provider Business Mailing Address
First Line	:	PO BOX 6002
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320-6002
Country	:	US
Telephone Number	:	423-284-8156
Fax Number	:

Provider Business Practice Location Address
First Line	:	4026 TOMAHAWK CIR NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3466
Country	:	US
Telephone Number	:	423-284-8156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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