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General NPI Number Information
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NPI Number | 1518483379
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Entity Type | Individual
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Provider Name | SCOTT ALAN FERNELIUS PHD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 1310 24TH AVE S
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City | NASHVILLE
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State | TN
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Zip | 37212-2637
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Country | US
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Telephone | 615-873-8314
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Fax |
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Provider Business Mailing Address
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Address Line | 645 OLD HICKORY BLVD APT 705
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City | NASHVILLE
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State | TN
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Zip | 37209-5259
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Country | US
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Telephone | 269-352-7002
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3352
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License Number State | TN
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