NPIMap

Organization Active NPI

Memphis Integral Neurofeedback Institute LLC

  • Psychologist
  • Cordova, TN
National Provider Identifier
1043639818
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
P1439 Issued in TN
Legal business name
MEMPHIS INTEGRAL NEUROFEEDBACK INSTITUTE LLC
Practice address
758 Walnut Knoll LN
Suite 101
Cordova, TN 38018-3112
Phone
(901) 624-0100
Fax
(901) 624-0778
NPI assigned
Apr 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dale Sherrod Foster, PHDNPI 1568444511
Title
Psychologist / Owner
Phone
(901) 624-0100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X P1439 TN Primary

Addresses

Primary practice location

758 Walnut Knoll LN
Suite 101
Cordova, TN 38018-3112

Mailing address

758 Walnut Knoll LN
Suite 101
Cordova, TN 38018-3112
Phone (901) 624-0100

Other names 1

  • Memphis Neurofeedback Other name

National Provider Directory

National Provider Directory

Locations

758 Walnut Knoll Ln
Ste 101
Cordova, TN 38018
Phone (901) 624-0100

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397001600000",
    "number": "1043639818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 WALNUT KNOLL LN",
            "address_2": "SUITE 101",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380183112",
            "telephone_number": "901-624-0100",
            "fax_number": "901-624-0778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 WALNUT KNOLL LN",
            "address_2": "SUITE 101",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380183112",
            "telephone_number": "901-624-0100",
            "fax_number": "901-624-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMPHIS INTEGRAL NEUROFEEDBACK INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-09",
        "last_updated": "2014-04-09",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "SHERROD",
        "authorized_official_title_or_position": "PSYCHOLOGIST / OWNER",
        "authorized_official_telephone_number": "901-624-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P1439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memphis Neurofeedback",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cordova, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.