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General NPI Number Information
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NPI Number | 1811763600
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Entity Type | Organization
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Legal Business Name | CLEVELAND COUNSELING & MENTAL HEALTH
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 1441 GUTHRIE DR NW STE 100
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City | CLEVELAND
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State | TN
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Zip | 37311-3642
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Country | US
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Telephone | 423-331-1869
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 GUTHRIE DR NW STE 100
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City | CLEVELAND
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State | TN
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Zip | 37311-3642
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Country | US
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Telephone | 423-331-1869
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | CHARIDITH ANNE FULLER
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Credential | MFT-I
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Telephone | 423-641-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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