MEDICARE: JUDITH A ALLSTON LCSW

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	104100000X	Social Worker	LSW0674	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4045761	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649240904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH A ALLSTON LCSW

Provider Business Mailing Address
First Line	:	1002 BRADFORD WAY
Second Line	:
City	:	KINGSTON
State	:	TN
Zip	:	37763-3100
Country	:	US
Telephone Number	:	865-376-1585
Fax Number	:	865-376-1587

Provider Business Practice Location Address
First Line	:	1002 BRADFORD WAY
Second Line	:
City	:	KINGSTON
State	:	TN
Zip	:	37763-3100
Country	:	US
Telephone Number	:	865-376-1585
Fax Number	:	865-376-1587

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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