Provider Demographics
NPI:1578854295
Name:LIVELY-BRINDLEY, LISA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:S
Last Name:LIVELY-BRINDLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:S
Other - Last Name:LIVELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:116 EPPS WOOD CT N
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-7890
Mailing Address - Country:US
Mailing Address - Phone:423-322-8395
Mailing Address - Fax:
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1392
Practice Address - Country:US
Practice Address - Phone:615-225-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003992103TC0700X
TN3717103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717OtherTENNESSEE LICENSE AS PSYCHOLOGIST AND HSP
CO0003992OtherCOLORADO LICENSE AS PSYCHOLOGIST