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General NPI Number Information
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NPI Number | 1649375619
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Entity Type | Individual
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Provider Name | DIANE ELIZABETH CAMP PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 04/30/2017
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Provider Practice Location Address
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Address Line | 5100 POPLAR AVE SUITE 510
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City | MEMPHIS
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State | TN
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Zip | 38137-4000
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Country | US
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Telephone | 901-572-1726
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Fax | 901-562-0386
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Provider Business Mailing Address
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Address Line | 5100 POPLAR AVE SUITE 510
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City | MEMPHIS
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State | TN
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Zip | 38137-4000
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Country | US
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Telephone | 901-572-1726
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Fax | 901-562-0386
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P0000001528
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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 | 31-455
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License Number State | MS
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