Healthcare Provider Details

I. General information

NPI: 1942247937
Provider Name (Legal Business Name): HERMAN PAUL STANLEY JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 LENOX PARK BLVD SUITE 214
MEMPHIS TN
38115-4299
US

IV. Provider business mailing address

3150 LENOX PARK BLVD SUITE 214
MEMPHIS TN
38115-4299
US

V. Phone/Fax

Practice location:
  • Phone: 901-273-2368
  • Fax: 901-273-2351
Mailing address:
  • Phone: 901-273-2368
  • Fax: 901-273-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP0000000997
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: