Healthcare Provider Details

I. General information

NPI: 1467440230
Provider Name (Legal Business Name): BRUCE E DAVIS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 21ST AVE S 2ND FLOOR SUITE 2200
NASHVILLE TN
37212-3160
US

IV. Provider business mailing address

1500 21ST AVE S 2ND FLOOR SUITE 2200
NASHVILLE TN
37212-3160
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-5408
  • Fax:
Mailing address:
  • Phone: 615-343-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC00732
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPE0000011472
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-02-0765
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: