MEDICARE: INTERACTIVE RESOURCES, LLC

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	101Y00000X	Counselor	LMHC #1834	FL
2	101Y00000X	Counselor	NCLPC #2280	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1187U	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1922007392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERACTIVE RESOURCES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 18958
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28814-0958
Country	:	US
Telephone Number	:	828-251-1948
Fax Number	:	828-299-7454

Provider Business Practice Location Address
First Line	:	150 CHATHAM RD
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28804-3361
Country	:	US
Telephone Number	:	828-251-1948
Fax Number	:	828-299-7454

Authorized Official
Title or Position	:	DIRECTOR - COUNSELOR
Name	:	DR. JARED DEAN MASSANARI
Credential	:	PH.D, MS-LPC
Telephone Number	:	828-251-1948

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/08/2013

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