Provider Demographics
NPI:1356797237
Name:SHOUN, KELLIE NICOLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:NICOLE
Last Name:SHOUN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:NICOLE
Other - Last Name:CUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1012
Mailing Address - Country:US
Mailing Address - Phone:347-439-8414
Mailing Address - Fax:
Practice Address - Street 1:LAMONT ST & VETERANS WAY
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3481
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator