Organization
PSYCAMORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY HAMILTON LCSW (LICENSED CLINICAL SOCIAL WORKER)
(662) 349-2818
Entity
Organization
Contact information
Practice address
563 CLARICE DR, MEMPHIS, TN 38109-4627
(901) 345-0637
Mailing address
563 CLARICE DR, MEMPHIS, TN 38109-4627
(901) 345-0637
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
C5871
MS
261QA0005X
Ambulatory Family Planning Facility
C5871
MS
261QM0855X
Adolescent and Children Mental Health Clinic/Center
C5871
MS
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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