Provider Demographics
NPI:1043369408
Name:BEATTY, DAWN MARIE (MA, EDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:MA, EDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MISSION CT
Mailing Address - Street 2:SUITE 904
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6440
Mailing Address - Country:US
Mailing Address - Phone:615-587-5490
Mailing Address - Fax:615-778-1837
Practice Address - Street 1:106 MISSION CT
Practice Address - Street 2:SUITE 904
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6440
Practice Address - Country:US
Practice Address - Phone:615-587-5490
Practice Address - Fax:615-587-5491
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000683106H00000X
TNP0000003237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441871Medicaid