Provider Demographics
NPI:1194925529
Name:PILLOW, DUDLEY B III (PSYD)
Entity type:Individual
Prefix:
First Name:DUDLEY
Middle Name:B
Last Name:PILLOW
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 WEST ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3869
Mailing Address - Country:US
Mailing Address - Phone:901-756-5730
Mailing Address - Fax:
Practice Address - Street 1:2176 WEST ST
Practice Address - Street 2:SUITE 200A
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3869
Practice Address - Country:US
Practice Address - Phone:901-756-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical