Healthcare Provider Details

I. General information

NPI: 1063578136
Provider Name (Legal Business Name): RICHARD DORSEY GILLESPIE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N WILLOW AVE
COOKEVILLE TN
38501
US

IV. Provider business mailing address

275 CUMBERLAND BND
NASHVILLE TN
37228-1805
US

V. Phone/Fax

Practice location:
  • Phone: 931-646-5600
  • Fax:
Mailing address:
  • Phone: 615-726-3340
  • Fax: 615-743-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: