Provider Demographics
NPI:1578569604
Name:PICKERING, DAVID E (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:PICKERING
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 1:78 CHIP OAK DR
Mailing Address - Street 2:
Mailing Address - City:MEDON
Mailing Address - State:TN
Mailing Address - Zip Code:38356-8128
Mailing Address - Country:US
Mailing Address - Phone:731-668-2277
Mailing Address - Fax:731-660-0510
Practice Address - Street 1:367B N PARKWAY
Practice Address - Street 2:STE 1
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2899
Practice Address - Country:US
Practice Address - Phone:731-668-2277
Practice Address - Fax:731-660-0510
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP-1223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3680830Medicare ID - Type Unspecified