MEDICARE: EVA ANN ALTIZER NED LPC MHSP

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	101Y00000X	Counselor	LPC1703	TN
2	101YP2500X	Professional Counselor	LPC1703	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4087213	OTHER	MAGELLAN SUMMIT
2	020107	OTHER	ANTHEM PROF TRIGON
3	368690	OTHER	MANAGED HEALTH NET
4	4087213	OTHER	MAGELLAN NAVIGATOR
5	020107	OTHER	ANTHEM PREF TRIGON
6	334969	OTHER	VALUEOPTIONS GROUP
7	4087213	OTHER	MAGELLAN PINNACLE

General Provider Information

NPI Number	:	1336152461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA ANN ALTIZER NED LPC MHSP

Provider Business Mailing Address
First Line	:	PO BOX 9054
Second Line	:
City	:	GRAY
State	:	TN
Zip	:	37615-9054
Country	:	US
Telephone Number	:	423-467-3600
Fax Number	:	423-467-3696

Provider Business Practice Location Address
First Line	:	1570 WAVERTY RD
Second Line	:	HOLSTON COUNSELING CTR
City	:	KINGSPORT
State	:	TN
Zip	:	37664
Country	:	US
Telephone Number	:	423-224-1300
Fax Number	:	423-224-1375

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	05/31/2026

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