Provider Demographics
NPI:1336406016
Name:DR. E. MCPHERSON BOTTS, PSY.D.
Entity Type:Organization
Organization Name:DR. E. MCPHERSON BOTTS, PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MCPHERSON
Authorized Official - Last Name:BOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:931-263-4824
Mailing Address - Street 1:1585 BRIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6815
Mailing Address - Country:US
Mailing Address - Phone:931-263-4824
Mailing Address - Fax:719-466-2073
Practice Address - Street 1:399 DOVER RD UNIT B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042
Practice Address - Country:US
Practice Address - Phone:931-263-4824
Practice Address - Fax:719-466-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2019-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1646103TC0700X
TN3423103TC0700X
CO3589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045451Medicaid
TNQ008340281OtherMEDICARE