Provider Demographics
NPI:1447245295
Name:DONALD, LIZ T (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIZ
Middle Name:T
Last Name:DONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 TAZEWELL PIKE
Mailing Address - Street 2:SUITE G
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1880
Mailing Address - Country:US
Mailing Address - Phone:865-924-0318
Mailing Address - Fax:865-470-7133
Practice Address - Street 1:2900 TAZEWELL PIKE
Practice Address - Street 2:SUITE G
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1880
Practice Address - Country:US
Practice Address - Phone:865-924-0318
Practice Address - Fax:865-470-7133
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3681456Medicaid
TN3681456Medicaid
TN3681456Medicare ID - Type Unspecified