Provider Demographics
NPI:1821162264
Name:GEROPSYCH, INC.
Entity Type:Organization
Organization Name:GEROPSYCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:KORTNER
Authorized Official - Last Name:NYGARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-289-3928
Mailing Address - Street 1:5364 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6234
Mailing Address - Country:US
Mailing Address - Phone:615-573-8069
Mailing Address - Fax:615-333-0676
Practice Address - Street 1:5364 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6234
Practice Address - Country:US
Practice Address - Phone:615-573-8069
Practice Address - Fax:615-333-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3982275Medicaid
TN3982275Medicaid