Miranda C Russell – Mental Health Counselor

Key facts

NPI: 1346572591
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
License: 2347 (TN)
Practice address: 105 Rowdy Row
Bean Station, TN 37708
Phone: (865) 767-3074
Fax: (865) 767-3076
NPI assigned: Feb 12, 2010
Sex: Female
Sole proprietor: No

Organizations & group practices 4

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.

East Tennessee State University Federally Qualified Health Center (FQHC) · Johnson City, TN · NPI 1093990608

Medicare reassignment Care Compare group NPD TN
East Tennessee State University Federally Qualified Health Center (FQHC) · Sneedville, TN · NPI 1326142563

Care Compare group NPD
East Tennessee State University Federally Qualified Health Center (FQHC) · Sneedville, TN · NPI 1215045976

Care Compare group
East Tennessee State University Federally Qualified Health Center (FQHC) · Johnson City, TN · NPI 1477660199

Care Compare group

Medicare Care Compare profile

Specialty: Mental Health Counselor
Education: Other, 2005
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: East Tennessee State University (21 clinicians)

Practice addresses (Care Compare)

391 Court St
Sneedville, TN 37869-0723
Phone (423) 733-2121

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TN
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20241015001690	TN	Practitioner - Mental Health Counselor	2860924917	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
East Tennessee State University		Current since Sep 30, 2024	Accepting new patients
East Tennessee State University		Current since Sep 30, 2024	Accepting new patients

Locations

2700 Main St
Sneedville, TN 37869
Phone (423) 733-2819

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X	2347	TN	Yes

Addresses

Primary practice location

105 Rowdy Row
Bean Station, TN 37708

Mailing address

438 Treadway Cir
Thorn Hill, TN 37881-5039
Phone (423) 733-9359

Other practice location 1

Hancock County Elementary School Based Health Center
391 Court Street
Sneedville, TN 37869-0723
Phone (423) 733-2121

Other practice location 2

2700 Main St
Sneedville, TN 37869-3041
Phone (423) 733-2819

Other providers in Bean Station, TN

All providers in Bean Station, TN · Mental Health Counselor in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.