Provider Demographics
NPI:1114164621
Name:MEDICAL PSYCHOLOGY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:MEDICAL PSYCHOLOGY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-680-7576
Mailing Address - Street 1:118 MAUPIN CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3781
Mailing Address - Country:US
Mailing Address - Phone:931-680-7576
Mailing Address - Fax:931-536-4346
Practice Address - Street 1:118 MAUPIN CIR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3781
Practice Address - Country:US
Practice Address - Phone:931-680-7576
Practice Address - Fax:931-536-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3683728Medicare PIN
TN3687153Medicare PIN
KY0793501Medicare PIN
TN39800021Medicare PIN