MEDICARE: MICAH CHRISTIAN RILEY

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	101YM0800X	Mental Health Counselor	6920	TN

General Provider Information

NPI Number	:	1922785989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAH CHRISTIAN RILEY

Provider Business Mailing Address
First Line	:	9724 KINGSTON PIKE STE 603
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6900
Country	:	US
Telephone Number	:	865-214-7371
Fax Number	:

Provider Business Practice Location Address
First Line	:	9724 KINGSTON PIKE STE 603
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6900
Country	:	US
Telephone Number	:	865-214-7371
Fax Number	:

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

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	11/24/2025

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