Provider Demographics
NPI:1154450765
Name:LAFFERTY, MELINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:LAFFERTY
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 1:4501 OLD CLARKSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-7922
Mailing Address - Country:US
Mailing Address - Phone:931-206-3231
Mailing Address - Fax:
Practice Address - Street 1:354 COOL SPRINGS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7252
Practice Address - Country:US
Practice Address - Phone:931-206-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3980680Medicaid
TN3980680Medicare ID - Type Unspecified