Healthcare Provider Details

I. General information

NPI: 1477970184
Provider Name (Legal Business Name): TAVIANNA M PATTERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MOUNT JULIET RD STE 130
MT JULIET TN
37122-6496
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-3173
  • Fax:
Mailing address:
  • Phone: 865-588-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5905
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: