Provider Demographics
NPI: | 1962248765 |
---|---|
Name: | ELDERBERRY PSYCHIATRIC CONSULTING |
Entity type: | Organization |
Organization Name: | ELDERBERRY PSYCHIATRIC CONSULTING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | FOUNDER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JEAN |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | SALCEDO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD, MBA |
Authorized Official - Phone: | 615-434-4892 |
Mailing Address - Street 1: | 6339 CHARLOTTE PIKE # 1027 |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37209-2926 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-434-4892 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 327 CALDWELL DR STE 500 |
Practice Address - Street 2: | |
Practice Address - City: | GOODLETTSVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37072-3410 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-239-1404 |
Practice Address - Fax: | 615-900-2716 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-07-02 |
Last Update Date: | 2024-07-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Single Specialty |