Provider Demographics
NPI:1245114867
Name:DEAM, KEVIN PATRICK
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:DEAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 S FLETCHER RUN CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2034
Mailing Address - Country:US
Mailing Address - Phone:856-912-9107
Mailing Address - Fax:
Practice Address - Street 1:6373 N QUAIL HOLLOW RD STE 202
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1405
Practice Address - Country:US
Practice Address - Phone:901-441-8322
Practice Address - Fax:901-347-1385
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health