Provider Demographics
NPI:1578680401
Name:HASH, MELISSA JILL
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JILL
Last Name:HASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1999
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-1999
Mailing Address - Country:US
Mailing Address - Phone:865-970-1295
Mailing Address - Fax:865-380-1461
Practice Address - Street 1:6800 BAUM DR
Practice Address - Street 2:BUILDING 3
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-7315
Practice Address - Country:US
Practice Address - Phone:865-374-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48461041C0700X
TN6464104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker