Healthcare Provider Details

I. General information

NPI: 1326632225
Provider Name (Legal Business Name): HAZEL HOUSE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 16TH AVE S
NASHVILLE TN
37212-2905
US

IV. Provider business mailing address

1503 16TH AVE S
NASHVILLE TN
37212-2905
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-3062
  • Fax:
Mailing address:
  • Phone: 615-499-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDSAY ERIN VAUGHN
Title or Position: FOUNDER / DIRECTOR
Credential: PSY.D.
Phone: 615-598-4260