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NPI Code Detail

MEDICARE: FAMILY MATTERS BRADLEY

MEDICARE: FAMILY MATTERS BRADLEY
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
1101YP2500XProfessional CounselorLPC0000000694TN

General Provider Information

NPI Number : 1467996504
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY MATTERS BRADLEY
Provider Business Mailing Address
First Line : 423 CENTRAL AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-4923
Country : US
Telephone Number : 423-476-1933
Fax Number : 423-559-1848
Provider Business Practice Location Address
First Line : 423 CENTRAL AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-4923
Country : US
Telephone Number : 423-476-1933
Fax Number : 423-559-1848
Authorized Official
Title or Position : CHAIRMAN OF BOARD
Name : DR. JOHN KIE VINING
Credential : CMIN, LPC, MHSP, NCC
Telephone Number : 423-476-1933
Provider Enumeration Date : 12/08/2016
Last Update Date : 12/08/2016

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Directions to “FAMILY MATTERS BRADLEY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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