Provider Demographics
NPI:1881165231
Name:PLATA, PAOLA (PSYD)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:PLATA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2670 UNION AVENUE EXT STE 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4416
Mailing Address - Country:US
Mailing Address - Phone:901-842-3160
Mailing Address - Fax:901-842-2360
Practice Address - Street 1:2861 BROAD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2903
Practice Address - Country:US
Practice Address - Phone:901-842-3161
Practice Address - Fax:901-842-2361
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4101103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical