Provider Demographics
NPI:1356137343
Name:GAYNOR, LESLIE SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:SUSAN
Last Name:GAYNOR
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 W END AVE RM 819
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1059
Mailing Address - Country:US
Mailing Address - Phone:615-421-0296
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LN STE 24100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4677
Practice Address - Country:US
Practice Address - Phone:615-936-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical