Provider Demographics
NPI:1790800266
Name:MCSPADDEN, ANNE MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MCSPADDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E YATES RD N
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2065
Mailing Address - Country:US
Mailing Address - Phone:901-683-0292
Mailing Address - Fax:
Practice Address - Street 1:156 W UNIVERSITY PKWY STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1617
Practice Address - Country:US
Practice Address - Phone:901-683-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001272103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling