MEDICARE: MR. BENJAMIN JAMES BILLER M.S. S.P.E.

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	103TC0700X	Clinical Psychologist	PE0000011766	TN

General Provider Information

NPI Number	:	1861556482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN JAMES BILLER M.S. S.P.E.

Provider Business Mailing Address
First Line	:	PO BOX 2965
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320-2965
Country	:	US
Telephone Number	:	423-479-5672
Fax Number	:	423-479-5679

Provider Business Practice Location Address
First Line	:	2292 CHAMBLISS AVE NW
Second Line	:	SUITE C-2
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3862
Country	:	US
Telephone Number	:	423-479-5672
Fax Number	:	423-479-5679

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	01/04/2010

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