Healthcare Provider Details

I. General information

NPI: 1710034277
Provider Name (Legal Business Name): CHERI L PREMEAU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 OLD TRENTON ROAD
CLARKSVILLE TN
37040
US

IV. Provider business mailing address

PO BOX 30429
CLARKSVILLE TN
37040-0008
US

V. Phone/Fax

Practice location:
  • Phone: 931-552-4171
  • Fax:
Mailing address:
  • Phone: 931-552-4171
  • Fax: 931-551-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1717
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1717
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: