Provider Demographics
NPI:1093115156
Name:BATTLE-GWATHNEY, LISA (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BATTLE-GWATHNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BATTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4322 HARDING PIKE
Mailing Address - Street 2:STE 417
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2664
Mailing Address - Country:US
Mailing Address - Phone:615-669-5279
Mailing Address - Fax:615-953-9239
Practice Address - Street 1:4235 HILLSBORO PIKE STE 300-504
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3344
Practice Address - Country:US
Practice Address - Phone:615-669-5279
Practice Address - Fax:615-953-9239
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE486103T00000X
TN3299 (PROVISIONAL)103TC1900X
TN3299103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034409Medicaid