Provider Demographics
NPI:1427093798
Name:PROFESSIONAL COUNSELING & MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:PROFESSIONAL COUNSELING & MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DOCKINS-PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:731-642-3600
Mailing Address - Street 1:230-B TYSON AVENUE
Mailing Address - Street 2:BOX 132
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-0132
Mailing Address - Country:US
Mailing Address - Phone:731-642-3600
Mailing Address - Fax:731-642-6037
Practice Address - Street 1:2920 HIGHWAY 641 N
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-8832
Practice Address - Country:US
Practice Address - Phone:731-642-3600
Practice Address - Fax:731-642-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3962101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508500OtherMEDICAID GROUP
TN39224262OtherMEDICARE GROUP