Provider Demographics
NPI:1699929224
Name:MASSEY, ETHEL JEAN
Entity type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:JEAN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1707 LOCKETT PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3923
Mailing Address - Country:US
Mailing Address - Phone:901-596-7645
Mailing Address - Fax:901-850-5725
Practice Address - Street 1:1707 LOCKETT PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3923
Practice Address - Country:US
Practice Address - Phone:901-596-7645
Practice Address - Fax:901-850-5725
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP0004631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical