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NPI Code Detail

MEDICARE: DR. AMY BALENTINE PH.D

MEDICARE: DR. AMY BALENTINE 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
1103T00000XPsychologistP0000002519TN

General Provider Information

NPI Number : 1902832272
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY BALENTINE PH.D
Provider Business Mailing Address
First Line : 1211 UNION AVE STE 330
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-6655
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8115 COUNTRY VILLAGE DR
Second Line :
City : CORDOVA
State : TN
Zip : 38016-2030
Country : US
Telephone Number : 901-752-2300
Fax Number : 901-752-2348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 09/15/2025

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