MEDICARE: COUNSELING AND FORENSIC SERVICES

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

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

General Provider Information

NPI Number	:	1235773748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING AND FORENSIC SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-0025
Country	:	US
Telephone Number	:	865-816-3166
Fax Number	:	865-225-9687

Provider Business Practice Location Address
First Line	:	481 LEEPER PKWY STE 6&7
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6174
Country	:	US
Telephone Number	:	865-816-3166
Fax Number	:	865-225-9687

Authorized Official
Title or Position	:	OWENER/THERAPIST
Name	:	MARY HELEN LYLE-JOINER
Credential	:	LPC-MHSP
Telephone Number	:	865-816-3166

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	08/29/2020

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1215894837 — MIRIAM LAGUNAS BSSW
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Directions to “COUNSELING AND FORENSIC SERVICES ” Practice Location

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