Provider Demographics
NPI:1821488834
Name:KANNAN, DIVYA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:KANNAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 WATERFORD CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2150
Mailing Address - Country:US
Mailing Address - Phone:901-340-4625
Mailing Address - Fax:
Practice Address - Street 1:2015 TERRACE PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2412
Practice Address - Country:US
Practice Address - Phone:612-322-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000003099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical