Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 486 | NE |
N | 103T00000X | Psychologist | 486 | NE |
Y | 103TC1900X | Counseling Psychologist | 3299 | TN |
N | 103TC1900X | Counseling Psychologist | 3299 (PROVISIONAL) | TN |
NPI | 1093115156 |
---|---|
Provider Name | Lisa Battle-Gwathney |
First Address | Nashville, TN 37205-2664 |
Second Address | Nashville, TN 37215-3344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 04/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q034409 | (05) | TN |