Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1063048106 |
---|---|
Provider Name | Elliott Nolan Devore |
First Address | Knoxville, TN 37917-8209 |
Second Address | Knoxville, TN 37996-4522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 20/03/2020 |