| Clinical And Forensic Psychology Professional Llc | |
|
812 N Charlotte St Dickson TN 37055-1009 | |
| (615) 446-8046 | |
| Not Available |
| Full Name | Clinical And Forensic Psychology Professional Llc |
|---|---|
| Speciality | Psychologist |
| Location | 812 N Charlotte St, Dickson, Tennessee |
| Authorized Official Name and Position | Kendra Davis (CREDENTIALING COODINATOR) |
| Authorized Official Contact | 8652462104 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical And Forensic Psychology Professional Llc Po Box 5777 Maryville TN 37802-5777 Ph: (865) 246-2104 | Clinical And Forensic Psychology Professional Llc 812 N Charlotte St Dickson TN 37055-1009 Ph: (615) 446-8046 |
| NPI Number | 1407333842 |
|---|---|
| Provider Enumeration Date | 07/27/2018 |
| Last Update Date | 07/27/2018 |
| Medicare PECOS PAC ID | 9931452364 |
|---|---|
| Medicare Enrollment ID | O20181031002633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407333842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 3431 (Tennessee) | Primary |
| Provider Name | Ron Nieberding |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235678764 PECOS PAC ID: 3971889049 Enrollment ID: I20170404002785 |
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