Basic Information
| Provider Information | |||||||||
| NPI: | 1477681435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRISON | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5833 AEDC RD | ||||||||
| Address2: | |||||||||
| City: | ESTILL SPRINGS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373303915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313924169 | ||||||||
| FaxNumber: | 9313924187 | ||||||||
| Practice Location | |||||||||
| Address1: | 11144 TULLAHOMA HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | TULLAHOMA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373886016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314549994 | ||||||||
| FaxNumber: | 9314555086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 12/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | P0000002340 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 4313470 | 01 | TN | BLUE CROSS | OTHER | 1527892 | 05 | TN | MEDICAID |