MEDICARE: ELIZABETH MARIE DESSIFY

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	6262	TN

General Provider Information

NPI Number	:	1447955695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARIE DESSIFY

Provider Business Mailing Address
First Line	:	300 SPRING ST APT 7
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2091
Country	:	US
Telephone Number	:	317-965-6684
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SPRING ST APT 7
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2091
Country	:	US
Telephone Number	:	317-965-6684
Fax Number	:

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

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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