Healthcare Provider Details

I. General information

NPI: 1477677433
Provider Name (Legal Business Name): AIMEE P MILTICH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE LYST PH.D.

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FARROW RD
MEMPHIS TN
38116-7116
US

IV. Provider business mailing address

570 BAKERS BRIDGE AVE
FRANKLIN TN
37067
US

V. Phone/Fax

Practice location:
  • Phone: 718-298-4375
  • Fax:
Mailing address:
  • Phone: 615-290-6668
  • Fax: 615-794-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2760
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: