Provider Demographics
NPI:1518194794
Name:UTT, RUDY M (LCSW)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:M
Last Name:UTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-2105
Mailing Address - Country:US
Mailing Address - Phone:423-745-8802
Mailing Address - Fax:423-744-7064
Practice Address - Street 1:118 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3636
Practice Address - Country:US
Practice Address - Phone:615-278-2241
Practice Address - Fax:615-904-9182
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW36931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical