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General NPI Number Information
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NPI Number | 1356485205
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Entity Type | Organization
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Legal Business Name | NASHVILLE NEUROPSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/22/2011
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Provider Practice Location Address
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Address Line | 2011 CHURCH ST SUITE 501
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City | NASHVILLE
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State | TN
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Zip | 37203-2000
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Country | US
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Telephone | 615-321-0101
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Fax | 615-284-4679
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Provider Business Mailing Address
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Address Line | 2011 CHURCH ST SUITE 501
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City | NASHVILLE
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State | TN
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Zip | 37203-2000
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Country | US
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Telephone | 615-321-0101
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Fax | 615-284-4679
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | CHRISTIAN EDWARD QUALLS
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Credential | PSY.D.
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Telephone | 615-321-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P2026
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License Number State | TN
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