Tammy Cupp, LPCC, LICDC
Individual provider Active NPI Professional Counselor · Bryan, OH
NPI 1285045203 · NPPES record last updated Mar 30, 2017
Key facts
- NPI
- 1285045203
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- E170024 (OH)
- Practice address
- 433 W High St
Bryan, OH 43506-1690 - Phone
- (419) 636-1131
- Fax
- (419) 636-3100
- NPI assigned
- May 13, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 161426 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| E170024 | OH | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E170024 | OH | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 161426 | OH |
Addresses
Primary practice location
433 W High St
Bryan, OH 43506-1690
Mailing address
PO Box 182
Blakeslee, OH 43505-0182
Phone (419) 633-7489
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0183607 | Medicaid | OH |
Other providers in Bryan, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.