MEDICARE: CHAD KINGERY LCPC, LAC

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	1718	TN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LAC-LIC-3401	MT
3	101YM0800X	Mental Health Counselor	BBH-PCLC-LIC-25856	MT
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	1718	TN

General Provider Information

NPI Number	:	1457771230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD KINGERY LCPC, LAC

Provider Business Mailing Address
First Line	:	200 TECH CENTER DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-2747
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 CONGRESS PKWY S
Second Line	:
City	:	ATHENS
State	:	TN
Zip	:	37303-2820
Country	:	US
Telephone Number	:	423-266-6751
Fax Number	:

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

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	11/22/2024

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