Healthcare Provider Details

I. General information

NPI: 1164067518
Provider Name (Legal Business Name): JARED SCOTT YAW PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MAYNOR ST
NASHVILLE TN
37216-3021
US

IV. Provider business mailing address

907 MAYNOR ST
NASHVILLE TN
37216-3021
US

V. Phone/Fax

Practice location:
  • Phone: 423-385-4349
  • Fax:
Mailing address:
  • Phone: 423-385-4349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3222
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3222
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3222
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3222
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: