Healthcare Provider Details

I. General information

NPI: 1437568466
Provider Name (Legal Business Name): ANDREW CUDD LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 KEITH ST NW STE 104
CLEVELAND TN
37312
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMT0000001143
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: