Provider Demographics
NPI:1215594403
Name:DOVER, KATELYN (MED)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:DOVER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 WESTGATE CIR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-866-9386
Mailing Address - Fax:615-866-9676
Practice Address - Street 1:1604 WESTGATE CIR
Practice Address - Street 2:SUITE 220
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-866-9386
Practice Address - Fax:615-866-9676
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5083101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional