Provider Demographics
NPI:1790166759
Name:NEELY, DANIEL ISAAC (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ISAAC
Last Name:NEELY
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 1:85 WHITE BRIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1564
Mailing Address - Country:US
Mailing Address - Phone:615-238-9100
Mailing Address - Fax:
Practice Address - Street 1:85 WHITE BRIDGE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1564
Practice Address - Country:US
Practice Address - Phone:615-238-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical