Healthcare Provider Details

I. General information

NPI: 1174799134
Provider Name (Legal Business Name): RYAN EVANS GILLESPIE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 21ST AVE SOUTH 1120 BAKER BUILDING
NASHVILLE TN
37203
US

IV. Provider business mailing address

110 21ST AVE SOUTH 1120 BAKER BUILDING
NASHVILLE TN
37203
US

V. Phone/Fax

Practice location:
  • Phone: 615-417-0885
  • Fax:
Mailing address:
  • Phone: 615-417-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2755
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: