NPIMap

Organization Active NPI

Psycamore, LLC

  • Clinic/Center
  • Memphis, TN
National Provider Identifier
1417258625
Registry record updated Nov 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
C5871 Issued in MS
Legal business name
PSYCAMORE, LLC
Practice address
563 Clarice Dr
Memphis, TN 38109-4627
Phone
(901) 345-0637
NPI assigned
Nov 4, 2010
Last updated
Nov 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2010

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

Authorized official

Name
Mr. Jerry Hamilton, LCSWNPI 1831386747
Title
Licensed Clinical Social Worker
Phone
(662) 349-2818

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X C5871 MS Primary
Ambulatory Family Planning Facility 261QA0005X C5871 MS
Adolescent and Children Mental Health Clinic/Center 261QM0855X C5871 MS

Addresses

Primary practice location

563 Clarice Dr
Memphis, TN 38109-4627

Mailing address

563 Clarice Dr
Memphis, TN 38109-4627
Phone (901) 345-0637

National Provider Directory

National Provider Directory
Tax ID family
Clement J Zablocki VA Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288828800000",
    "number": "1417258625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "563 CLARICE DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381094627",
            "telephone_number": "901-345-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "563 CLARICE DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381094627",
            "telephone_number": "901-345-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCAMORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-04",
        "last_updated": "2010-11-04",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "662-349-2818",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "C5871",
            "primary": true
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": "MS",
            "license": "C5871",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MS",
            "license": "C5871",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2010; 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.