Healthcare Provider Details

I. General information

NPI: 1114164621
Provider Name (Legal Business Name): MEDICAL PSYCHOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MAUPIN CIR
SHELBYVILLE TN
37160-3781
US

IV. Provider business mailing address

118 MAUPIN CIR
SHELBYVILLE TN
37160-3781
US

V. Phone/Fax

Practice location:
  • Phone: 931-680-7576
  • Fax: 931-536-4346
Mailing address:
  • Phone: 931-680-7576
  • Fax: 931-536-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA L NORTH
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-680-7576