Provider Demographics
NPI:1184450520
Name:FILL YOUR CUPP THERAPY LLC
Entity type:Organization
Organization Name:FILL YOUR CUPP THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-329-9568
Mailing Address - Street 1:16200 SW PACIFIC HWY STE H
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14087 SW SPRINGBROOK LN
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2026
Practice Address - Country:US
Practice Address - Phone:971-329-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty