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General NPI Number Information
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NPI Number | 1417988965
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Entity Type | Organization
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Legal Business Name | PSYCHOPHARMACOLOGY ASSOCIATES, INC.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 112 QUAIL HOLLOW LN
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City | SHELBYVILLE
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State | TN
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Zip | 37160-7162
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Country | US
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Telephone | 931-680-4370
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Fax | 931-680-4370
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Provider Business Mailing Address
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Address Line | PO BOX 743
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City | LEBANON
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State | TN
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Zip | 37088-0743
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Country | US
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Telephone | 931-680-4370
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Fax | 931-680-4699
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES M REAVIS
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Credential |
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Telephone | 931-680-4370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P0000002187
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P0000000878
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License Number State | TN
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