Healthcare Provider Details

I. General information

NPI: 1811439110
Provider Name (Legal Business Name): TRAVERSE COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 2ND ST NW
CLEVELAND TN
37311-5014
US

IV. Provider business mailing address

PO BOX 2224
CLEVELAND TN
37320-2224
US

V. Phone/Fax

Practice location:
  • Phone: 423-310-8206
  • Fax: 888-858-1871
Mailing address:
  • Phone: 423-310-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSHUA ZELLO
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC-MHSP
Phone: 423-310-8206