Provider Demographics
NPI:1497908859
Name:BOTTS, ELIZABETH MCPHERSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MCPHERSON
Last Name:BOTTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1585 BRIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6815
Mailing Address - Country:US
Mailing Address - Phone:931-263-4824
Mailing Address - Fax:719-466-2073
Practice Address - Street 1:399 DOVER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4133
Practice Address - Country:US
Practice Address - Phone:931-263-4824
Practice Address - Fax:719-466-2073
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2019-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1646103TC0700X
CO3589103TC0700X
TN3423103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008340281OtherMEDICARE
TNQ045451Medicaid