MEDICARE: BELOVED COUNSELING CENTER, LLC

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

General Provider Information

NPI Number	:	1629883384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELOVED COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	9724 KINGSTON PIKE STE 602
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6900
Country	:	US
Telephone Number	:	865-333-4550
Fax Number	:

Provider Business Practice Location Address
First Line	:	9724 KINGSTON PIKE STE 602
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6900
Country	:	US
Telephone Number	:	865-333-4550
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY M SERRANO
Credential	:	LPC-MHSP, NCC
Telephone Number	:	865-333-4550

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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