Provider Demographics
NPI:1639502305
Name:AMBRESTER, MARCUS LAROY III (MA)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:LAROY
Last Name:AMBRESTER
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 PATTERSON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2126
Mailing Address - Country:US
Mailing Address - Phone:615-653-9198
Mailing Address - Fax:
Practice Address - Street 1:1916 PATTERSON ST STE 208
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2126
Practice Address - Country:US
Practice Address - Phone:615-653-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst