Provider Demographics
NPI:1447698568
Name:DR. MARY WANAT PLLC
Entity type:Organization
Organization Name:DR. MARY WANAT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANAT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-756-8398
Mailing Address - Street 1:8820 TRINITY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2735
Mailing Address - Country:US
Mailing Address - Phone:901-385-2342
Mailing Address - Fax:901-382-0140
Practice Address - Street 1:8820 TRINITY RD STE 200
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2735
Practice Address - Country:US
Practice Address - Phone:901-385-2342
Practice Address - Fax:901-382-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3064204OtherBCBS