| Pediatric Psychiatric Professional Llc | |
|
1661 International Dr Ste 400 Memphis TN 38120-1431 | |
| (713) 628-8199 | |
| (901) 425-9726 |
| Full Name | Pediatric Psychiatric Professional Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 1661 International Dr Ste 400, Memphis, Tennessee |
| Authorized Official Name and Position | Charles Randale Frith (OPERATIONS MANAGER) |
| Authorized Official Contact | 3185279322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Psychiatric Professional Llc Po Box 17452 Memphis TN 38187-0452 Ph: (318) 527-9322 | Pediatric Psychiatric Professional Llc 1661 International Dr Ste 400 Memphis TN 38120-1431 Ph: (713) 628-8199 |
| NPI Number | 1811719834 |
|---|---|
| Provider Enumeration Date | 10/30/2024 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811719834 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
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