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2611 Salem Creek Dr Murfreesboro TN 37128-5587 | |
| (615) 310-1491 | |
| (615) 848-0337 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2611 Salem Creek Dr, Murfreesboro, Tennessee |
| Authorized Official Name and Position | Nicole Parker (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 6153101491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2611 Salem Creek Dr Murfreesboro TN 37128-5587 Ph: (615) 310-1491 | 2611 Salem Creek Dr Murfreesboro TN 37128-5587 Ph: (615) 310-1491 |
| NPI Number | 1053530469 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 09/22/2021 |
| Certification Date | 08/31/2021 |
| Medicare PECOS PAC ID | 0749459782 |
|---|---|
| Medicare Enrollment ID | O20110809000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053530469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2431 (Tennessee) | Primary |
| Provider Name | Kenith Robins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417105792 PECOS PAC ID: 7517003577 Enrollment ID: I20091005000366 |
| Provider Name | Lisa M Webb |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1609058130 PECOS PAC ID: 2365611308 Enrollment ID: I20110809000732 |
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