Provider Demographics
NPI:1063048106
Name:DEVORE, ELLIOTT NOLAN (MED, MA)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:NOLAN
Last Name:DEVORE
Suffix:
Gender:M
Credentials:MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-8209
Mailing Address - Country:US
Mailing Address - Phone:865-599-4748
Mailing Address - Fax:
Practice Address - Street 1:1800 VOLUNTEER BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-4522
Practice Address - Country:US
Practice Address - Phone:865-974-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling