Basic Information
Provider Information
NPI: 1124188479
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: QUINN
FirstName: BRYNDA
MiddleName: MARIE
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2004 HAYES ST STE 800
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372032659
CountryCode: US
TelephoneNumber: 6153290570
FaxNumber: 6153290579
Practice Location
Address1: 5653 FRIST BLVD STE 434
Address2:  
City: HERMITAGE
State: TN
PostalCode: 37076
CountryCode: US
TelephoneNumber: 6158719996
FaxNumber: 6158719661
Other Information
ProviderEnumerationDate: 12/09/2006
LastUpdateDate: 10/17/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X2634TNY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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