Healthcare Provider Details

I. General information

NPI: 1356489827
Provider Name (Legal Business Name): GINA L PRIGOFF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E BROOKHAVEN CIR SUITE 5
MEMPHIS TN
38117-4547
US

IV. Provider business mailing address

740 E BROOKHAVEN CIR SUITE 5
MEMPHIS TN
38117-4547
US

V. Phone/Fax

Practice location:
  • Phone: 901-268-4964
  • Fax: 901-685-1686
Mailing address:
  • Phone: 901-268-4964
  • Fax: 901-685-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2315
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: