Healthcare Provider Details

I. General information

NPI: 1649768870
Provider Name (Legal Business Name): RIVER CITY NEUROPSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 INTERNATIONAL DR., SUITE 400
MEMPHIS TN
38120
US

IV. Provider business mailing address

1661 INTERNATIONAL PLACE DR STE 400
MEMPHIS TN
38120-1431
US

V. Phone/Fax

Practice location:
  • Phone: 901-410-9524
  • Fax: 901-432-2415
Mailing address:
  • Phone: 901-410-9524
  • Fax: 901-432-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2840
License Number StateTN

VIII. Authorized Official

Name: DR. NEELAM JAIN
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PHD
Phone: 901-410-9524