Provider Demographics
NPI:1659131183
Name:LAVAY, BRONTE
Entity Type:Individual
Prefix:
First Name:BRONTE
Middle Name:
Last Name:LAVAY
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 1:9005 OVERLOOK BLVD STE 637
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5269
Mailing Address - Country:US
Mailing Address - Phone:615-733-4651
Mailing Address - Fax:
Practice Address - Street 1:5209 LINBAR DR STE 625
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-1025
Practice Address - Country:US
Practice Address - Phone:615-733-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1483103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst