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General NPI Number Information
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NPI Number | 1831130384
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Entity Type | Individual
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Provider Name | MICHAEL CANNON LOFTIN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 750 OLD HICKORY BLVD BLDG #2, SUITE 150
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City | BRENTWOOD
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State | TN
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Zip | 37027-4528
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Country | US
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Telephone | 615-371-6188
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Fax | 615-595-2865
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Provider Business Mailing Address
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Address Line | 1230 LIMERICK LN
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City | FRANKLIN
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State | TN
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Zip | 37067-8514
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Country | US
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Telephone | 615-371-6188
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Fax | 615-595-2865
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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 | P0000002412
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License Number State | TN
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