MEDICARE: GEORGE THOMAS DELBRIDGE III LCSW

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	101YM0800X	Mental Health Counselor	6827	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6827	OTHER	TN	LCSW

General Provider Information

NPI Number	:	1417517897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE THOMAS DELBRIDGE III LCSW

Provider Business Mailing Address
First Line	:	122 W BARTON RIDGE RD
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-6199
Country	:	US
Telephone Number	:	662-321-2545
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 W BARTON RIDGE RD
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-6199
Country	:	US
Telephone Number	:	662-321-2545
Fax Number	:

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	03/07/2023

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