MEDICARE: GREENWOOD COUNSELING CENTER TN, PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1770397903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD COUNSELING CENTER TN, PLLC

Provider Business Mailing Address
First Line	:	108 DALE AVE
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3849
Country	:	US
Telephone Number	:	704-682-0384
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 IMPERIAL BLVD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3440
Country	:	US
Telephone Number	:	704-360-3641
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACKIE KURTZ
Credential	:
Telephone Number	:	704-682-0384

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	02/06/2025

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