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NPI Code Detail

MEDICARE: KELLIE HUMBERT KNAPP LPC-MHSP

MEDICARE: KELLIE HUMBERT KNAPP LPC-MHSP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor4608TN

General Provider Information

NPI Number : 1841823960
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE HUMBERT KNAPP LPC-MHSP
Provider Business Mailing Address
First Line : 2307 EDGEMON ST. SE
Second Line :
City : CLEVELAND
State : TN
Zip : 37323
Country : US
Telephone Number : 423-506-5943
Fax Number :
Provider Business Practice Location Address
First Line : 423 CENTRAL AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-4923
Country : US
Telephone Number : 423-476-1933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2020
Last Update Date : 02/17/2020

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