Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | P0000001933 | TN |
N | 103TH0100X | Health Service | P0000001933 | TN |
NPI | 1497862411 |
---|---|
Provider Name | Dr. Mary Anne Knack |
First Address | Memphis, TN 38135-9492 |
Second Address | Memphis, TN 38104-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |