MEDICARE: MRS. HEATHER L RYERSON LPC/MHSP

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	2027	TN

General Provider Information

NPI Number	:	1427244763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER L RYERSON LPC/MHSP

Provider Business Mailing Address
First Line	:	3251 SOMERSET DR SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-0422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 PEERLESS RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3834
Country	:	US
Telephone Number	:	423-284-2439
Fax Number	:

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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