MEDICARE: MS. SUE ELLEN LINDEN B.S.

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

General Provider Information

NPI Number	:	1396885463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE ELLEN LINDEN B.S.

Provider Business Mailing Address
First Line	:	199 CARRIAGE TRAIL
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-2637
Country	:	US
Telephone Number	:	865-560-2587
Fax Number	:	865-560-2580

Provider Business Practice Location Address
First Line	:	911 CROSS PARK DR
Second Line	:	SUITE E-475
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4505
Country	:	US
Telephone Number	:	865-560-2598
Fax Number	:	865-560-2580

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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