Provider Demographics
NPI:1932557345
Name:SOUTHEAST PSYCH NASHVILLE, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST PSYCH NASHVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:HASTY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:615-373-9955
Mailing Address - Street 1:5409 MARYLAND WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5037
Mailing Address - Country:US
Mailing Address - Phone:615-373-9955
Mailing Address - Fax:
Practice Address - Street 1:5409 MARYLAND WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5037
Practice Address - Country:US
Practice Address - Phone:615-373-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty