MEDICARE: MARY CATHERINE RIDENOUR 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	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor	4544	TN

General Provider Information

NPI Number	:	1679810063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CATHERINE RIDENOUR LPC-MHSP

Provider Business Mailing Address
First Line	:	1240 E MOODY AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-2540
Country	:	US
Telephone Number	:	865-603-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 N CEDAR BLUFF RD # 305
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-3607
Country	:	US
Telephone Number	:	865-325-2085
Fax Number	:

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	08/12/2019

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