=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073979563
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT E LEVEY PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2016
-----------------------------------------------------
Last Update Date | 01/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1924 ALCOA HWY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-670-6700
-----------------------------------------------------
Fax | 865-670-6198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 440027
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37244-0027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-670-6199
-----------------------------------------------------
Fax | 865-670-6198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 782
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------