Individual
DR. TAHERE POURMOTABBED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
8110 CORDOVA RD, CORDOVA, TN 38016-0520
(901) 757-0568
(901) 754-8247
Mailing address
8110 CORDOVA RD, CORDOVA, TN 38016-0520
(901) 757-0568
(901) 754-8247
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000002344
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3387193
—
TN
01
—
4094352
BCBS OF TN
TN
Enumeration date
11/16/2006
Last updated
07/08/2007
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