Provider Demographics
NPI:1124101431
Name:BEEVERS, LORRIE GENE (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRIE
Middle Name:GENE
Last Name:BEEVERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 EMORY VALLEY RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7756
Mailing Address - Country:US
Mailing Address - Phone:865-212-5296
Mailing Address - Fax:865-212-5296
Practice Address - Street 1:679 EMORY VALLEY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7756
Practice Address - Country:US
Practice Address - Phone:865-212-5296
Practice Address - Fax:865-212-5296
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3688319Medicare ID - Type Unspecified
TN0035268Medicare UPIN