Healthcare Provider Details

I. General information

NPI: 1053717694
Provider Name (Legal Business Name): CHELSEY M WYLDE PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEY MORRISON PSY. D

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 HIGHWAY 45 BYP
JACKSON TN
38305-3618
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-1375
  • Fax: 731-660-8370
Mailing address:
  • Phone: 731-425-5752
  • Fax: 731-422-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number13402
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: