Healthcare Provider Details

I. General information

NPI: 1568593705
Provider Name (Legal Business Name): MARY CUPP LCADC,CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY FIGG CADC

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 ALPINE DR
SHELBYVILLE KY
40065-8880
US

IV. Provider business mailing address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax:
Mailing address:
  • Phone: 502-589-8600
  • Fax: 502-589-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number166044
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: