Healthcare Provider Details

I. General information

NPI: 1740345438
Provider Name (Legal Business Name): BERNARD CHARLES IHRIG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2006
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ATHENS WAY STE 104
NASHVILLE TN
37228-1351
US

IV. Provider business mailing address

220 ATHENS WAY STE 104
NASHVILLE TN
37228-1351
US

V. Phone/Fax

Practice location:
  • Phone: 615-320-1155
  • Fax: 615-320-1177
Mailing address:
  • Phone: 615-320-1155
  • Fax: 615-320-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1472
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2361
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2361
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2361
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2361
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2361
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: