Healthcare Provider Details

I. General information

NPI: 1265433296
Provider Name (Legal Business Name): PAUL J NEAL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 CENTRAL AVENUE
MEMPHIS TN
38111-7602
US

IV. Provider business mailing address

3950 CENTRAL AVENUE
MEMPHIS TN
38111-7602
US

V. Phone/Fax

Practice location:
  • Phone: 901-458-6291
  • Fax: 901-323-4848
Mailing address:
  • Phone: 901-458-6291
  • Fax: 901-323-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP0000000953
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberP0000000953
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000000953
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: