Provider Demographics
NPI:1497718639
Name:GERMANTOWN PSYCHOLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GERMANTOWN PSYCHOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARALEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOTTUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-755-5802
Mailing Address - Street 1:7516 ENTERPRISE AVE
Mailing Address - Street 2:#1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3802
Mailing Address - Country:US
Mailing Address - Phone:901-755-5802
Mailing Address - Fax:901-757-2249
Practice Address - Street 1:7516 ENTERPRISE AVE
Practice Address - Street 2:#1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3802
Practice Address - Country:US
Practice Address - Phone:901-755-5802
Practice Address - Fax:901-757-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty