MEDICARE: LISA BATTLE-GWATHNEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	486	NE
2	103TC1900X	Counseling Psychologist	3299 (PROVISIONAL)	TN
3	103TC1900X	Counseling Psychologist	3299	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093115156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BATTLE-GWATHNEY PH.D.

Provider Business Mailing Address
First Line	:	4322 HARDING PIKE
Second Line	:	STE 417
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2664
Country	:	US
Telephone Number	:	615-669-5279
Fax Number	:	615-953-9239

Provider Business Practice Location Address
First Line	:	4235 HILLSBORO PIKE STE 300-504
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3344
Country	:	US
Telephone Number	:	615-669-5279
Fax Number	:	615-953-9239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/04/2021

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