Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | P2872 | TN |
Y | 103G00000X | Clinical Psychologist | P2872 | TN |
Y | 103TC0700X | Clinical Psychologist | P2872 | TN |
N | 103G00000X | Clinical Psychologist | P2872 (PROV) | TN |
N | 103TC0700X | Clinical Psychologist | P2872 (PROV) | TN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | P2872 | TN |
NPI | 1235334350 |
---|---|
Provider Name | Marcella Horn Dunaway |
First Address | Maryville, TN 37802-4068 |
Second Address | Maryville, TN 37804-5153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 11/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1517021 | (05) | TN |