Provider Demographics
NPI:1831130384
Name:LOFTIN, MICHAEL CANNON (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CANNON
Last Name:LOFTIN
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 1:1230 LIMERICK LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8514
Mailing Address - Country:US
Mailing Address - Phone:615-371-6188
Mailing Address - Fax:615-595-2865
Practice Address - Street 1:750 OLD HICKORY BLVD
Practice Address - Street 2:BLDG #2, SUITE 150
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4528
Practice Address - Country:US
Practice Address - Phone:615-371-6188
Practice Address - Fax:615-595-2865
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3585304Medicaid
TN4047159OtherBCBS OF TENNESSEE
TN4133923OtherBLUE CROSS BLUE SHIELD TN