Healthcare Provider Details

I. General information

NPI: 1154539021
Provider Name (Legal Business Name): KENNETH PAUL LASS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 22ND AVE N STE 2
NASHVILLE TN
37203-1810
US

IV. Provider business mailing address

331 22ND AVE N STE 2
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:
Title or Position:
Credential:
Phone: