Healthcare Provider Details

I. General information

NPI: 1912162520
Provider Name (Legal Business Name): MELISSA CUPP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 MIDDLEBROOK PIKE
KNOXVILLE TN
37921-6503
US

IV. Provider business mailing address

200 TECH CENTER DR
KNOXVILLE TN
37912-2747
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-9711
  • Fax: 865-541-6942
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5263
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: