=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093115156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA BATTLE-GWATHNEY PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2014
-----------------------------------------------------
Last Update Date | 08/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4235 HILLSBORO PIKE STE 300-504
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37215-3344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-669-5279
-----------------------------------------------------
Fax | 615-953-9239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4322 HARDING PIKE STE 417
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-669-5279
-----------------------------------------------------
Fax | 615-953-9239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 486
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 3299 (PROVISIONAL)
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 3299
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------