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NPI Code Detail

MEDICARE: DR. DAVID M DEASON PH.D.

MEDICARE: DR. DAVID M DEASON 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
1103TB0200XCognitive & Behavioral PsychologistP0000002200TN
2103TC1900XCounseling PsychologistP0000002200TN
3103TC2200XClinical Child & Adolescent PsychologistP0000002200TN
4103TF0000XFamily PsychologistP0000002200TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12050882OTHERTNCIGNA
24029335OTHERTNTN BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1285634758
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID M DEASON PH.D.
Provider Business Mailing Address
First Line : 3950 CENTRAL AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-7602
Country : US
Telephone Number : 901-458-6291
Fax Number : 901-323-4848
Provider Business Practice Location Address
First Line : 3950 CENTRAL AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-7602
Country : US
Telephone Number : 901-458-6291
Fax Number : 901-323-4848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 02/04/2008

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Directions to “ DR. DAVID M DEASON PH.D.” Practice Location

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