Provider Demographics
NPI:1942247937
Name:STANLEY, HERMAN PAUL JR (PHD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:PAUL
Last Name:STANLEY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 LENOX PARK BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4299
Mailing Address - Country:US
Mailing Address - Phone:901-273-2368
Mailing Address - Fax:901-273-2351
Practice Address - Street 1:3150 LENOX PARK BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4299
Practice Address - Country:US
Practice Address - Phone:901-273-2368
Practice Address - Fax:901-273-2351
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000000997103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3685276Medicaid
TN3685276Medicaid
TN3685276Medicare PIN