Provider Demographics
NPI:1497909634
Name:GRANT, KRISTIN LEE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LEE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 RIDEOUT LN
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7607
Mailing Address - Country:US
Mailing Address - Phone:615-895-0710
Mailing Address - Fax:615-225-0545
Practice Address - Street 1:2615 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3213
Practice Address - Country:US
Practice Address - Phone:615-895-0710
Practice Address - Fax:615-225-0545
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2971103T00000X
TNP0000002971103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service