Provider Demographics
NPI:1740439017
Name:PUNCOCHAR, BEA DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:BEA
Middle Name:DAVID
Last Name:PUNCOCHAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BIEKE
Other - Middle Name:DAVID
Other - Last Name:PUNCOCHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:214 CENTERVIEW DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5274
Mailing Address - Country:US
Mailing Address - Phone:615-370-4977
Mailing Address - Fax:615-370-9412
Practice Address - Street 1:214 CENTERVIEW DR
Practice Address - Street 2:SUITE 290
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5274
Practice Address - Country:US
Practice Address - Phone:615-370-4977
Practice Address - Fax:615-370-9412
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical