Healthcare Provider Details

I. General information

NPI: 1962079046
Provider Name (Legal Business Name): GERMANTOWN BEHAVIORAL SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3059 FOREST HILL IRENE RD STE 104
GERMANTOWN TN
38138-7808
US

IV. Provider business mailing address

3059 FOREST HILL IRENE RD STE 104
GERMANTOWN TN
38138-7808
US

V. Phone/Fax

Practice location:
  • Phone: 901-499-5459
  • Fax:
Mailing address:
  • Phone: 901-499-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: EMILY VANDERPOOL
Title or Position: OWNER
Credential:
Phone: 901-499-5459