Provider Demographics
NPI:1467440230
Name:DAVIS, BRUCE E (PHD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 21ST AVE S
Mailing Address - Street 2:2ND FLOOR SUITE 2200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3160
Mailing Address - Country:US
Mailing Address - Phone:615-343-5408
Mailing Address - Fax:
Practice Address - Street 1:1500 21ST AVE S
Practice Address - Street 2:2ND FLOOR SUITE 2200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3160
Practice Address - Country:US
Practice Address - Phone:615-343-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC00732101YP2500X
TNPE0000011472103TM1800X
TN1-02-0765103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities