Healthcare Provider Details

I. General information

NPI: 1336496645
Provider Name (Legal Business Name): KATIE BETH PRICE-VERDELL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1617
US

IV. Provider business mailing address

156 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1617
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-0749
  • Fax: 731-736-1358
Mailing address:
  • Phone: 731-394-0749
  • Fax: 731-736-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3251
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: