| Germantown Psychological Associates Pc | |
|
7516 Enterprise Ave #1 Germantown TN 38138-3802 | |
| (901) 755-5802 | |
| (901) 757-2249 |
| Full Name | Germantown Psychological Associates Pc |
|---|---|
| Speciality | Psychologist |
| Location | 7516 Enterprise Ave, Germantown, Tennessee |
| Authorized Official Name and Position | Daraleen K Hottum (ADMINISTRATOR) |
| Authorized Official Contact | 9017555802 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Germantown Psychological Associates Pc 7516 Enterprise Ave #1 Germantown TN 38138-3802 Ph: (901) 755-5802 | Germantown Psychological Associates Pc 7516 Enterprise Ave #1 Germantown TN 38138-3802 Ph: (901) 755-5802 |
| NPI Number | 1497718639 |
|---|---|
| Provider Enumeration Date | 04/10/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3779537667 |
|---|---|
| Medicare Enrollment ID | O20050303000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497718639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Richard L Luscomb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821067752 PECOS PAC ID: 6305890294 Enrollment ID: I20120607000649 |
| Provider Name | Karen D Sanders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346219599 PECOS PAC ID: 8820345895 Enrollment ID: I20180721000081 |
| Provider Name | Alicia L Autry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528519576 PECOS PAC ID: 7810247871 Enrollment ID: I20180912002446 |
| Provider Name | Kaylee A Bruijn |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1346748662 PECOS PAC ID: 6800228768 Enrollment ID: I20191114000359 |
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