Provider Demographics
NPI:1073641205
Name:KEN LASS, PHD
Entity Type:Organization
Organization Name:KEN LASS, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-460-4232
Mailing Address - Street 1:331 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1810
Mailing Address - Country:US
Mailing Address - Phone:615-320-1481
Mailing Address - Fax:615-460-4202
Practice Address - Street 1:331 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1810
Practice Address - Country:US
Practice Address - Phone:615-320-1481
Practice Address - Fax:615-460-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3685376Medicare ID - Type Unspecified