Active NPI
David C Dietrich, PHD
- Clinical Psychologist
- Memphis, TN
National Provider Identifier
1477708543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P2010
- Practice address
- 3150 Lenox Park Blvd
Suite 214
Memphis, TN 38115-4299 - Phone
- (901) 273-2370
- Fax
- (901) 273-2351
- NPI assigned
- Nov 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P2010 | TN | Primary |
Addresses
Primary practice location
3150 Lenox Park Blvd
Suite 214
Memphis, TN 38115-4299
Mailing address
3150 Lenox Park Blvd
Suite 214
Memphis, TN 38115-4299
Phone (901) 273-2370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P2010 | TN | MD | Clinical Psychologist |
| 2010 | TN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1477708543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3150 LENOX PARK BLVD",
"address_2": "SUITE 214",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381154299",
"telephone_number": "901-273-2370",
"fax_number": "901-273-2341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 LENOX PARK BLVD",
"address_2": "SUITE 214",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381154299",
"telephone_number": "901-273-2370",
"fax_number": "901-273-2351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "DAVID",
"middle_name": "C",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-17",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P2010",
"primary": true
}
],
"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 Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.