Andrew William Dipastena, MFT TEMP LICENSE

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1914 Issued in TN

Practice address

2200 Chambliss Ave NW
Cleveland, TN 37311-3874

Phone

(423) 599-9347

NPI assigned

Jan 7, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Therapy LLC.

  • Community/Behavioral Health Agency
  • Cleveland, TN
  • NPI 1780576223
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1003577370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 EVERHART DR NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373111622",
            "telephone_number": "423-544-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 CHAMBLISS AVE NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113874",
            "telephone_number": "423-599-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIPASTENA",
        "first_name": "ANDREW",
        "middle_name": "WILLIAM",
        "credential": "MFT TEMP LICENSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-07",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TN",
            "license": "1914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Cleveland",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2200 Chambliss Ave NW",
            "city": "Cleveland",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373113874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James Michael Dickson, MD
• Jenna Dickson
• Lindsey Diederich
• Maurice Michael Dieterle, BA
• Mary Digiulio, D.O.
• Divergent Roads Counseling
• Elani Marie Dodd, APRN
• Don C. Harting, MD PC
• Donald E Robinson MD
• Kloe Kukta Dorn, OTD, OTR/L,

• Marriage & Family Therapist in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Marriage & Family Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.