Basic Information
| Provider Information | |||||||||
| NPI: | 1578894887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMPHIS CENTER FOR WOMEN AND FAMILIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5154 STAGE RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381343118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013729133 | ||||||||
| FaxNumber: | 9013721015 | ||||||||
| Practice Location | |||||||||
| Address1: | 5154 STAGE RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381343118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013729133 | ||||||||
| FaxNumber: | 9013721015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2010 | ||||||||
| LastUpdateDate: | 01/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | PAUL | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9013729133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.