Provider Demographics
NPI:1508034372
Name:HAREN, ELIZABETH GAYE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GAYE
Last Name:HAREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 W LYTTLETON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3439
Mailing Address - Country:US
Mailing Address - Phone:423-737-2866
Mailing Address - Fax:
Practice Address - Street 1:6305 LONAS DR STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3203
Practice Address - Country:US
Practice Address - Phone:865-588-3173
Practice Address - Fax:865-588-3174
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC00000001437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional