Provider Demographics
NPI:1245527589
Name:CUPPLES, TIMOTHY MARK (CIT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARK
Last Name:CUPPLES
Suffix:
Gender:M
Credentials:CIT
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Mailing Address - Street 1:310 MID CONTINENT PLZ
Mailing Address - Street 2:6TH FLOOR SUITE 602
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1760
Mailing Address - Country:US
Mailing Address - Phone:870-735-2499
Mailing Address - Fax:870-735-2496
Practice Address - Street 1:310 MID CONTINENT PLZ
Practice Address - Street 2:6TH FLOOR SUITE 602
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1760
Practice Address - Country:US
Practice Address - Phone:870-735-2499
Practice Address - Fax:870-735-2496
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)