Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | P3155 | TN |
N | 103T00000X | Psychologist | P3155 | TN |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | P3155 | TN |
NPI | 1003071515 |
---|---|
Provider Name | Dr. Heather Kreth |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-3133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS01191 | PROFESSIONAL LICENSE (01) | RI |