Provider Demographics
NPI:1538458260
Name:MASSAC, LAUTURE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUTURE
Middle Name:
Last Name:MASSAC
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 1:190 HILL TOP LN
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-3821
Mailing Address - Country:US
Mailing Address - Phone:931-296-4930
Mailing Address - Fax:931-296-8002
Practice Address - Street 1:190 HILL TOP LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-3821
Practice Address - Country:US
Practice Address - Phone:931-296-4930
Practice Address - Fax:931-296-8002
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2922103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical