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General NPI Number Information
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NPI Number | 1316945504
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Entity Type | Individual
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Provider Name | KEVIN SCOTT CORUM LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 210 SIMMONS ST
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City | MARYVILLE
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State | TN
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Zip | 37801-4750
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Country | US
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Telephone | 865-970-9800
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Fax | 865-983-4518
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Provider Business Mailing Address
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Address Line | 2334 BOB CARNES RD
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City | KNOXVILLE
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State | TN
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Zip | 37924-1801
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Country | US
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Telephone | 865-964-5882
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Fax | 865-689-4443
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4705
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License Number State | TN
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