MEDICARE: WITHIN HOLISTIC COUNSELING, INC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1891407987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITHIN HOLISTIC COUNSELING, INC

Provider Business Mailing Address
First Line	:	200 MIDLAKE DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918
Country	:	US
Telephone Number	:	865-985-1084
Fax Number	:	888-796-6903

Provider Business Practice Location Address
First Line	:	1000 CORPORATE POINTE
Second Line	:	SUITE 106
City	:	WARNER ROBBINS
State	:	GA
Zip	:	31088
Country	:	US
Telephone Number	:	865-297-5077
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGEMENT
Name	:	JAMIE PADGETT
Credential	:
Telephone Number	:	865-404-3469

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	12/20/2022

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