Provider Demographics
NPI:1346930419
Name:DEPEW, MARK ALAN
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:DEPEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 WEBB ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686
Mailing Address - Country:US
Mailing Address - Phone:910-723-1416
Mailing Address - Fax:
Practice Address - Street 1:JHQVAMC
Practice Address - Street 2:CORNER OF LAMONT AND VETERANS WAY - 116V
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor