MEDICARE: DR. JAMI GRICH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2428	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4080146	OTHER	TN	MAGELLAN

General Provider Information

NPI Number	:	1184778433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMI GRICH PH.D.

Provider Business Mailing Address
First Line	:	2120 CRESTMOOR RD STE 3016
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2613
Country	:	US
Telephone Number	:	615-293-2301
Fax Number	:	615-385-4113

Provider Business Practice Location Address
First Line	:	2120 CRESTMOOR RD STE 3016
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2613
Country	:	US
Telephone Number	:	615-293-2301
Fax Number	:	615-385-4113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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