Provider Demographics
NPI:1073755716
Name:BAGBY, MICHELLE LYNN
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:BAGBY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3203 BRICK CHURCH PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2800
Mailing Address - Country:US
Mailing Address - Phone:615-262-7822
Mailing Address - Fax:615-262-7823
Practice Address - Street 1:3203 BRICK CHURCH PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2800
Practice Address - Country:US
Practice Address - Phone:615-262-7822
Practice Address - Fax:615-262-7823
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst