MEDICARE: DR. LASHAUNDA POINDEXTER MASSEY 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	2377	TN

General Provider Information

NPI Number	:	1891848164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LASHAUNDA POINDEXTER MASSEY PH.D.

Provider Business Mailing Address
First Line	:	5209 COTSWOLD LN
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-4543
Country	:	US
Telephone Number	:	901-452-6424
Fax Number	:	901-452-6425

Provider Business Practice Location Address
First Line	:	2693 UNION AVENUE EXT
Second Line	:	STE #200
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4403
Country	:	US
Telephone Number	:	901-452-6424
Fax Number	:	901-452-6425

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	11/14/2008

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