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General NPI Number Information
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NPI Number | 1063048106
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Entity Type | Individual
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Provider Name | ELLIOTT NOLAN DEVORE M.ED., M.A.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 1800 VOLUNTEER BLVD
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City | KNOXVILLE
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State | TN
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Zip | 37996-4522
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Country | US
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Telephone | 865-974-2196
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Fax |
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Provider Business Mailing Address
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Address Line | 2333 JEFFERSON AVE
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City | KNOXVILLE
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State | TN
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Zip | 37917-8209
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Country | US
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Telephone | 865-599-4748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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