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General NPI Number Information
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NPI Number | 1831382365
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Entity Type | Organization
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Legal Business Name | ELBOW TREE CHRISTIAN COUNSELING, LLC
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 3069 BROAD ST SUITE 6
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City | CHATTANOOGA
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State | TN
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Zip | 37408-3047
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Country | US
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Telephone | 423-517-7070
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Fax | 423-894-9275
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Provider Business Mailing Address
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Address Line | 3069 BROAD ST SUITE 6
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City | CHATTANOOGA
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State | TN
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Zip | 37408-3047
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Country | US
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Telephone | 423-517-7070
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Fax | 423-894-9275
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MR. STEVE MCILVAINE
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Credential | M.A.
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Telephone | 423-517-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 560
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License Number State | TN
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