MEDICARE: JON MARK COLLINGS LCSW LMHP CMSW

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	1041C0700X	Clinical Social Worker	LSW4029	TN

General Provider Information

NPI Number	:	1750376851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON MARK COLLINGS LCSW LMHP CMSW

Provider Business Mailing Address
First Line	:	DEPARTMENT 888182
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37995-0001
Country	:	US
Telephone Number	:	800-355-3565
Fax Number	:	423-714-2355

Provider Business Practice Location Address
First Line	:	601 COLLEGE ST
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-6712
Country	:	US
Telephone Number	:	865-544-0406
Fax Number	:	865-544-0480

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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