Provider Demographics
NPI:1922059054
Name:COHEN, MELISSA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:COHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:KEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2507 MINERAL SPRINGS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1549
Mailing Address - Country:US
Mailing Address - Phone:865-688-0661
Mailing Address - Fax:865-688-5780
Practice Address - Street 1:2507 MINERAL SPRINGS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1549
Practice Address - Country:US
Practice Address - Phone:865-688-0661
Practice Address - Fax:865-688-5780
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000003735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153468OtherBCBS PROVIDER NUMBER
TN3923663Medicaid
TN3923663Medicaid