Healthcare Provider Details

I. General information

NPI: 1073641205
Provider Name (Legal Business Name): KEN LASS, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 22ND AVE N
NASHVILLE TN
37203-1810
US

IV. Provider business mailing address

331 22ND AVE N
NASHVILLE TN
37203-1810
US

V. Phone/Fax

Practice location:
  • Phone: 615-320-1481
  • Fax: 615-460-4202
Mailing address:
  • Phone: 615-320-1481
  • Fax: 615-460-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP0000001356
License Number StateTN

VIII. Authorized Official

Name: DR. KENNETH PAUL LASS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 615-460-4232