Provider Demographics
NPI:1073862827
Name:RABY, JOANN PAULA (PHD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:PAULA
Last Name:RABY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 HIGHWAY 305 N
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9066
Mailing Address - Country:US
Mailing Address - Phone:662-895-9776
Mailing Address - Fax:
Practice Address - Street 1:5119 SUMMER AVE STE 233
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4417
Practice Address - Country:US
Practice Address - Phone:901-683-6296
Practice Address - Fax:901-767-2936
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1867103TC0700X
MS46751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical