MEDICARE: CLEVELAND BEHAVIORAL HEALTH, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	36406	TN

General Provider Information

NPI Number	:	1396923553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND BEHAVIORAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	3555 KEITH ST NW
Second Line	:	SUITE 102
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-728-2282
Fax Number	:	423-728-2234

Provider Business Practice Location Address
First Line	:	3555 KEITH ST NW
Second Line	:	SUITE 102
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-728-2282
Fax Number	:	423-728-2234

Authorized Official
Title or Position	:	OWNER
Name	:	NIANSEN LIU
Credential	:	M.D., PH.D.
Telephone Number	:	423-728-2282

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	07/25/2009

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