Provider Demographics
NPI:1790106193
Name:KATZ JESOP, MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:KATZ JESOP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 OVERLOOK BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5269
Mailing Address - Country:US
Mailing Address - Phone:615-719-2392
Mailing Address - Fax:
Practice Address - Street 1:9005 OVERLOOK BLVD STE 117
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5269
Practice Address - Country:US
Practice Address - Phone:615-719-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000003446103TC0700X
WAPY00003666103TC0700X
COPSY.0003961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical