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NPI Code Detail

MEDICARE: DR. MARY ANNE KNACK PH.D.

MEDICARE: DR. MARY ANNE KNACK 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
1103TC1900XCounseling PsychologistP0000001933TN
2103TH0100XHealth Service PsychologistP0000001933TN

General Provider Information

NPI Number : 1497862411
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ANNE KNACK PH.D.
Provider Business Mailing Address
First Line : 6470 BELMONT CV
Second Line :
City : MEMPHIS
State : TN
Zip : 38135-9492
Country : US
Telephone Number : 901-377-8684
Fax Number :
Provider Business Practice Location Address
First Line : 1030 JEFFERSON AVE
Second Line : 116A4
City : MEMPHIS
State : TN
Zip : 38104-2127
Country : US
Telephone Number : 901-523-8990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 03/15/2026

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