Basic Information
| Provider Information | |||||||||
| NPI: | 1730307349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SORRELL | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 339 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378045831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659831899 | ||||||||
| FaxNumber: | 8652330465 | ||||||||
| Practice Location | |||||||||
| Address1: | 339 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378045831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659831899 | ||||||||
| FaxNumber: | 8652330465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2007 | ||||||||
| LastUpdateDate: | 01/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | TN | N | Behavioral Health & Social Service Providers | Psychologist | School | 103TH0100X | 2584 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 1520407 | 05 | TN | MEDICAID |