Provider Demographics
NPI:1215988340
Name:COHEN, MICHAEL E (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:COHEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
TNLSW0000003156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3698925Medicaid
TN3051728OtherBCBS PROVIDER NUMBER
TN3051728OtherBCBS PROVIDER NUMBER