Provider Demographics
NPI:1245302298
Name:GRISHAM, WILLIAM MAX (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MAX
Last Name:GRISHAM
Suffix:
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 1:671 ANTEBELLUM CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1774
Mailing Address - Country:US
Mailing Address - Phone:901-850-1586
Mailing Address - Fax:901-854-9822
Practice Address - Street 1:245 GERMANTOWN BEND CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7238
Practice Address - Country:US
Practice Address - Phone:901-759-3616
Practice Address - Fax:901-759-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP961103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3685205Medicare ID - Type UnspecifiedPROVIDER #