Provider Demographics
NPI:1447243480
Name:LEMAY, MARK A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LEMAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E BROADWAY BLVD
Mailing Address - Street 2:STE. 203
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2837
Mailing Address - Country:US
Mailing Address - Phone:865-475-9199
Mailing Address - Fax:865-475-9193
Practice Address - Street 1:222 E BROADWAY BLVD
Practice Address - Street 2:STE. 203
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2837
Practice Address - Country:US
Practice Address - Phone:865-475-9199
Practice Address - Fax:865-475-9193
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3682771Medicaid
TNR96004Medicare UPIN
TN3682771Medicaid