Provider Demographics
NPI:1356489827
Name:PRIGOFF, GINA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:L
Last Name:PRIGOFF
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 1:740 E BROOKHAVEN CIR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4547
Mailing Address - Country:US
Mailing Address - Phone:901-268-4964
Mailing Address - Fax:901-685-1686
Practice Address - Street 1:740 E BROOKHAVEN CIR
Practice Address - Street 2:SUITE 5
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4547
Practice Address - Country:US
Practice Address - Phone:901-268-4964
Practice Address - Fax:901-685-1686
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2315103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling