MEDICARE: MR. SCOTT BRADY HOLLENBECK MED LMFT LPCMHSP LAD

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LDC273	TN
2	101YP2500X	Professional Counselor	LPC747	TN
3	106H00000X	Marriage & Family Therapist	LMT562	TN

General Provider Information

NPI Number	:	1558400473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT BRADY HOLLENBECK MED LMFT LPCMHSP LAD

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	:	401 HOLSTON DRIVE
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743
Country	:	US
Telephone Number	:	423-639-1104
Fax Number	:	423-636-8368

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	01/18/2026

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