MEDICARE: CLEVELAND COUNSELING & MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1811763600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND COUNSELING & MENTAL HEALTH

Provider Business Mailing Address
First Line	:	1441 GUTHRIE DR NW STE 100
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3642
Country	:	US
Telephone Number	:	423-331-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 GUTHRIE DR NW STE 100
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3642
Country	:	US
Telephone Number	:	423-331-1869
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PSYCHOTHERAPIST
Name	:	CHARIDITH ANNE FULLER
Credential	:	MFT-I
Telephone Number	:	423-641-1105

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	12/01/2023

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