Provider Demographics
NPI:1730138819
Name:LEMOND, CAROLYN M (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:LEMOND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5100 POPLAR AVE
Mailing Address - Street 2:SUITE 2740
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38137-4000
Mailing Address - Country:US
Mailing Address - Phone:901-682-7901
Mailing Address - Fax:901-767-4255
Practice Address - Street 1:5100 POPLAR AVE
Practice Address - Street 2:SUITE 2740
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38137-4000
Practice Address - Country:US
Practice Address - Phone:901-682-7901
Practice Address - Fax:901-767-4255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3981469Medicare ID - Type Unspecified