| Fouche Psychological Services Pllc | |
|
3006 Greystone Sq Jackson TN 38305-3589 | |
| (860) 230-6947 | |
| Not Available |
| Full Name | Fouche Psychological Services Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 3006 Greystone Sq, Jackson, Tennessee |
| Authorized Official Name and Position | Sophia Belay Fouche (OWNER) |
| Authorized Official Contact | 8602306947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fouche Psychological Services Pllc 119 Barnes Rd Medina TN 38355-8697 Ph: (860) 230-6947 | Fouche Psychological Services Pllc 3006 Greystone Sq Jackson TN 38305-3589 Ph: (860) 230-6947 |
| NPI Number | 1073259065 |
|---|---|
| Provider Enumeration Date | 05/11/2022 |
| Last Update Date | 05/23/2022 |
| Certification Date | 05/23/2022 |
| Medicare PECOS PAC ID | 9931588738 |
|---|---|
| Medicare Enrollment ID | O20220624002205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073259065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sophia Fouche |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1871995977 PECOS PAC ID: 7911226683 Enrollment ID: I20150430000944 |
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