Organization
BRADLEY CLEVELAND REHAB SERVICES
Active
Organization
BRADLEY CLEVELAND REHAB SERVICES
Active
Other names
Youth Counseling Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN KIE VINING DMIN, LPC (CHAIRMAN OF BOARD)
(423) 476-1933
Entity
Organization
Contact information
Practice address
423 CENTRAL AVE NW, CLEVELAND, TN 37311-4923
(423) 476-1933
(423) 559-1848
Mailing address
423 CENTRAL AVE NW, CLEVELAND, TN 37311-4923
(423) 476-1933
(423) 559-1848
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
L214-117-2195
TN
251S00000X
Community/Behavioral Health Agency
Primary
LPC0000000694
TN
Other
Enumeration date
02/08/2008
Last updated
01/05/2017
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