MEDICARE: LIVING PROOF COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	106H00000X	Marriage & Family Therapist
3	171M00000X	Case Manager/Care Coordinator
4	175T00000X	Peer Specialist
5	221700000X	Art Therapist
6	225600000X	Dance Therapist
7	225700000X	Massage Therapist
8	225800000X	Recreation Therapist
9	225A00000X	Music Therapist
10	226000000X	Recreational Therapist Assistant
11	251S00000X	Community/Behavioral Health Agency
12	261QM1300X	Multi-Specialty Clinic/Center
13	347C00000X	Private Vehicle
14	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
15	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013571884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING PROOF COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2928 E MAGNOLIA AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37914-4515
Country	:	US
Telephone Number	:	865-765-3797
Fax Number	:	865-999-7858

Provider Business Practice Location Address
First Line	:	391 BROAD ST NW STE 201
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5039
Country	:	US
Telephone Number	:	423-444-0998
Fax Number	:	865-999-7858

Authorized Official
Title or Position	:	FACILITY DIRECTOR
Name	:	EDGAR TYRONE FRITZ
Credential	:	LCSW
Telephone Number	:	865-765-3797

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	02/06/2023

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