MEDICARE: ELIZABETH A GATES PMHNP, LPC-MHSP, MAC

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
2	101YP2500X	Professional Counselor	3134	TN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	36141	TN

General Provider Information

NPI Number	:	1831383017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A GATES PMHNP, LPC-MHSP, MAC

Provider Business Mailing Address
First Line	:	5819 WINDING LN
Second Line	:	SUITE 133
City	:	HIXSON
State	:	TN
Zip	:	37343-3631
Country	:	US
Telephone Number	:	423-290-7237
Fax Number	:	423-285-6160

Provider Business Practice Location Address
First Line	:	5819 WINDING LN STE 133
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4067
Country	:	US
Telephone Number	:	423-290-7237
Fax Number	:	423-285-6160

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	04/17/2024

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