Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1229 | TN |
Y | 103TC0700X | Clinical Psychologist | 1229 | TN |
NPI | 1013118934 |
---|---|
Provider Name | Jerry Melcher |
First Address | Jackson, TN 38305-4436 |
Second Address | Jackson, TN 38305-2170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 29/07/2009 |