MEDICARE: MATT DRINNEN 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
2	101YP2500X	Professional Counselor	2465	TN

General Provider Information

NPI Number	:	1609905587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATT DRINNEN LPC/MHSP

Provider Business Mailing Address
First Line	:	PO BOX 32293
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37930-2293
Country	:	US
Telephone Number	:	865-755-1174
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 ESSARY DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-2409
Country	:	US
Telephone Number	:	865-755-1174
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	10/04/2010

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