Healthcare Provider Details

I. General information

NPI: 1124482005
Provider Name (Legal Business Name): CALYX PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4646 POPLAR AVE STE 412
MEMPHIS TN
38117-4434
US

IV. Provider business mailing address

PO BOX 4071
CORDOVA TN
38088-4071
US

V. Phone/Fax

Practice location:
  • Phone: 901-300-2217
  • Fax:
Mailing address:
  • Phone: 901-300-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3010
License Number StateTN

VIII. Authorized Official

Name: AUDREY LINDALE TOWNSEL
Title or Position: OWNER
Credential: PSYCHOLOGIST
Phone: 901-270-5752