Individual
JEROME BURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
222 22ND AVE N, NASHVILLE, TN 37203
(629) 255-2168
(629) 255-4051
Mailing address
222 22ND AVE N, NASHVILLE, TN 37203-1852
(629) 255-3486
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2496
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3980754
—
TN
Enumeration date
11/02/2005
Last updated
06/28/2018
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