Provider Demographics
NPI:1043423551
Name:KERTAY, LES (PHD)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:
Last Name:KERTAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:P
Other - Last Name:KERTAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5 CRESCENT PARK
Mailing Address - Street 2:
Mailing Address - City:RIDGESIDE
Mailing Address - State:TN
Mailing Address - Zip Code:37411-2611
Mailing Address - Country:US
Mailing Address - Phone:423-488-5990
Mailing Address - Fax:
Practice Address - Street 1:5 CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:RIDGESIDE
Practice Address - State:TN
Practice Address - Zip Code:37411-2611
Practice Address - Country:US
Practice Address - Phone:423-488-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical