NPI 1760464937 · live from the CMS NPI Registry
Heather L Beaudry, PhD
Psychologist, Clinical in Johnson City, TN. National Provider Identifier 1760464937, active.
NPI record
| NPI | 1760464937 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical 103TC0700X |
| Practice location | 1907 N Roan St Ste 207, Johnson City, TN 37601 |
| Practice phone | 423-282-0164 |
| Enumerated | November 15, 2005 |
| Last updated | April 12, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Clinical primary | 103TC0700X | TN2735 (TN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.