MEDICARE: JULIE GARDENHIRE LMFT

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	106H00000X	Marriage & Family Therapist	1397	TN

General Provider Information

NPI Number	:	1699323782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE GARDENHIRE LMFT

Provider Business Mailing Address
First Line	:	3555 KEITH ST NW STE 104
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-310-8201
Fax Number	:	888-858-1871

Provider Business Practice Location Address
First Line	:	3555 KEITH ST NW STE 104
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-310-8201
Fax Number	:	888-858-1871

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

Provider Enumeration Date	:	08/31/2019
Last Update Date	:	08/31/2019

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