Provider Demographics
NPI:1598961823
Name:CROUSE, ELLEN MAHONEY (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MAHONEY
Last Name:CROUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:NEWBERG
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 JEFFERSON AVE
Mailing Address - Street 2:NEUROPSYCHOLOGY CLINIC, #116A4
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2127
Mailing Address - Country:US
Mailing Address - Phone:901-523-8990
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:603-359-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT26505163WX0002X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk