Provider Demographics
NPI:1164504494
Name:TICHON, MARK (PSYCHOLOGIST/HSP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:TICHON
Suffix:
Gender:M
Credentials:PSYCHOLOGIST/HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 WOODCHASE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1626
Mailing Address - Country:US
Mailing Address - Phone:865-406-5646
Mailing Address - Fax:
Practice Address - Street 1:704 WOODCHASE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1626
Practice Address - Country:US
Practice Address - Phone:865-406-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2038101YP2500X
TN2786103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional