Healthcare Provider Details

I. General information

NPI: 1447340518
Provider Name (Legal Business Name): DONNA LYNN MOORE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WESTGATE CIRCLE STE 295 CENTERSTONE ASSOC
BRENTWOOD TN
37027
US

IV. Provider business mailing address

PO BOX 40406 CENTERSTONE ASSOC
NASHVILLE TN
37204-0406
US

V. Phone/Fax

Practice location:
  • Phone: 615-661-4443
  • Fax: 615-370-2408
Mailing address:
  • Phone: 615-463-4174
  • Fax: 615-460-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP02182
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: