Doctor Name: | LAUREL ELISE HENEGAR |
NPI Number: | 1538147590 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPE |
License Number: | PE1467 |
Business Practice Address: | 6350 W Andrew Johnson Highway Talbott, TN - 37877 |
Business Phone Number: | 4235877337 |
Business Fax Number: | 4237142355 |
Mailing Address: | 6350 W A J Hwy, Department 100 TALBOTT |
State: | TN |
Postal Code: | 378778605 |
Phone Number: | 8003553565 |
Fax Number: | 4237142355 |
NPI Enumeration Date: | 01/09/2006 |
NPI Last Update Date: | 02/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | PE1467 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |