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General NPI Number Information
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NPI Number | 1851569412
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Entity Type | Organization
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Legal Business Name | DAVID PICKERING
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 367B N PARKWAY STE 1
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City | JACKSON
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State | TN
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Zip | 38305-2899
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Country | US
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Telephone | 731-668-2277
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Fax | 731-660-0510
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Provider Business Mailing Address
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Address Line | 367B N PARKWAY STE 1
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City | JACKSON
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State | TN
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Zip | 38305-2899
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Country | US
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Telephone | 731-668-2277
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Fax | 731-660-0510
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID E. PICKERING
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Credential | PH.D.
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Telephone | 731-668-2277
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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 | P1223
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License Number State | TN
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