MEDICARE: COURTNEY LILJEKVIST

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	106H00000X	Marriage & Family Therapist	2048	TN

General Provider Information

NPI Number	:	1174105480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY LILJEKVIST

Provider Business Mailing Address
First Line	:	1441 GUTHRIE DR NW STE 205
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3642
Country	:	US
Telephone Number	:	423-922-9423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 GUTHRIE DR NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3642
Country	:	US
Telephone Number	:	423-922-9423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	03/19/2024

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