Healthcare Provider Details

I. General information

NPI: 1760113286
Provider Name (Legal Business Name): CHATTANOOGA COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 BROAD ST
CHATTANOOGA TN
37408-3084
US

IV. Provider business mailing address

3555 KEITH ST NW STE 104
CLEVELAND TN
37312-4375
US

V. Phone/Fax

Practice location:
  • Phone: 423-417-3161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIEA ZELLO
Title or Position: OWNER
Credential:
Phone: 423-417-3161