MEDICARE: HEARTS SET FREE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1476	TN
2	106H00000X	Marriage & Family Therapist	117	TN

General Provider Information

NPI Number	:	1043656507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTS SET FREE

Provider Business Mailing Address
First Line	:	183 1ST NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311
Country	:	US
Telephone Number	:	423-544-3059
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 1ST ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5003
Country	:	US
Telephone Number	:	423-544-3059
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DONALD EARL SMITH JR.
Credential	:
Telephone Number	:	423-457-1634

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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Directions to “HEARTS SET FREE ” Practice Location

Language	Start Address	Practice Location

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