Provider Demographics
NPI:1013118934
Name:MELCHER, JERRY (CLINICAL PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:MELCHER
Suffix:
Gender:M
Credentials:CLINICAL PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 HIGHWAY 45 BYP
Mailing Address - Street 2:SUITE 604
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4436
Mailing Address - Country:US
Mailing Address - Phone:731-660-8759
Mailing Address - Fax:
Practice Address - Street 1:50 BENT CREEK LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2170
Practice Address - Country:US
Practice Address - Phone:731-661-9109
Practice Address - Fax:731-661-9110
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3682657Medicare ID - Type UnspecifiedMEDICARE