Basic Information
Provider Information | |||||||||
NPI: | 1093941809 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KING | ||||||||
FirstName: | DANIELLE | ||||||||
MiddleName: | RANAE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VOSS | ||||||||
OtherFirstName: | DANIELLE | ||||||||
OtherMiddleName: | RANAE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PSY.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1923 SULPHUR SPRINGS RD | ||||||||
Address2: |   | ||||||||
City: | MORRISTOWN | ||||||||
State: | TN | ||||||||
PostalCode: | 378135654 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4233179344 | ||||||||
FaxNumber: | 4237142355 | ||||||||
Practice Location | |||||||||
Address1: | 2574 FRAYSER BLVD | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381275829 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9013024361 | ||||||||
FaxNumber: | 8653420121 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2009 | ||||||||
LastUpdateDate: | 03/29/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY8417 | FL | N |   | Behavioral Health & Social Service Providers | Psychologist |   | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 103TC0700X | P2985 | TN | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.