MEDICARE: RECOVERY CLINIC GROUP TENNESSEE INC

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	2084P0800X	Psychiatry Physician
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1558005579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY CLINIC GROUP TENNESSEE INC

Provider Business Mailing Address
First Line	:	106 MISSION CT STE 201A
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6441
Country	:	US
Telephone Number	:	615-390-2865
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 MISSION CT STE 201A
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6441
Country	:	US
Telephone Number	:	615-390-2865
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN D LEE
Credential	:
Telephone Number	:	615-973-3500

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	10/07/2022

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