Healthcare Provider Details

I. General information

NPI: 1538307194
Provider Name (Legal Business Name): BEHAVIORAL HEALTH AND ASSESSMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 WALNUT GROVE RD SUITE 103
MEMPHIS TN
38111-3537
US

IV. Provider business mailing address

3100 WALNUT GROVE RD SUITE 103
MEMPHIS TN
38111-3537
US

V. Phone/Fax

Practice location:
  • Phone: 901-454-9233
  • Fax: 901-881-0674
Mailing address:
  • Phone: 901-454-9233
  • Fax: 901-881-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2682
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4783
License Number StateTN

VIII. Authorized Official

Name: DR. HUGH D MOORE
Title or Position: OWNER
Credential: PH.D.
Phone: 901-454-9233