Provider Demographics
NPI:1649768870
Name:RIVER CITY NEUROPSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:RIVER CITY NEUROPSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-410-9524
Mailing Address - Street 1:1661 INTERNATIONAL PLACE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1431
Mailing Address - Country:US
Mailing Address - Phone:901-410-9524
Mailing Address - Fax:901-432-2415
Practice Address - Street 1:1661 INTERNATIONAL DR., SUITE 400
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-410-9524
Practice Address - Fax:901-432-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4273584OtherBCBS
3033849OtherCIGNA