Healthcare Provider Details

I. General information

NPI: 1124029251
Provider Name (Legal Business Name): DANIEL RACHLIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HILLCREST DR SUITE 107
CLARKSVILLE TN
37043-5000
US

IV. Provider business mailing address

130 HILLCREST DR STE 103
CLARKSVILLE TN
37043-5064
US

V. Phone/Fax

Practice location:
  • Phone: 931-553-8500
  • Fax: 931-553-8544
Mailing address:
  • Phone: 931-542-6463
  • Fax: 931-542-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2472
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: