Provider Demographics
NPI:1518530153
Name:COUPER, KATELYN NICOLE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:NICOLE
Last Name:COUPER
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:NICOLE
Other - Last Name:MORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:525 N STATE OF FRANKLIN RD STE 9
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8213
Practice Address - Country:US
Practice Address - Phone:423-302-3480
Practice Address - Fax:423-722-3009
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional