Provider Demographics
NPI:1881109957
Name:SCOVILLE, ELIZABETH G (MS, LPC-MHSP (T))
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:SCOVILLE
Suffix:
Gender:F
Credentials:MS, LPC-MHSP (T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MERCOMATIC DR APT 103
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3051
Mailing Address - Country:US
Mailing Address - Phone:615-417-3661
Mailing Address - Fax:
Practice Address - Street 1:805 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2105
Practice Address - Country:US
Practice Address - Phone:615-334-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN4674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health