Provider Demographics
NPI:1588769442
Name:CHILD & ADOLESCENT PSYCHIATRY ASSOCIATES
Entity type:Organization
Organization Name:CHILD & ADOLESCENT PSYCHIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-752-1980
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 233
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0233
Mailing Address - Country:US
Mailing Address - Phone:901-752-1980
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:1135 CULLY RD
Practice Address - Street 2:#100
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016
Practice Address - Country:US
Practice Address - Phone:901-752-1980
Practice Address - Fax:901-309-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730256Medicaid
TN3730256Medicaid