Provider Demographics
NPI:1326364134
Name:CHATTANOOGA CENTER FOR PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:CHATTANOOGA CENTER FOR PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARZI
Authorized Official - Middle Name:L
Authorized Official - Last Name:RADPOUR-WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-400-3825
Mailing Address - Street 1:112 S CREST RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-5519
Mailing Address - Country:US
Mailing Address - Phone:423-400-3825
Mailing Address - Fax:423-870-4774
Practice Address - Street 1:545 OAK ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1906
Practice Address - Country:US
Practice Address - Phone:423-400-3825
Practice Address - Fax:423-870-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002532103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty