Healthcare Provider Details

I. General information

NPI: 1386856565
Provider Name (Legal Business Name): LYNNE D ZAGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1617
US

IV. Provider business mailing address

156 WEST UNIVERSITY PKWY PSYCHOLOGICAL SERVICES
JACKSON TN
38305-1616
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-0749
  • Fax: 731-512-3874
Mailing address:
  • Phone: 731-394-0749
  • Fax: 731-512-3874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP000000859
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: