Provider Demographics
NPI:1992706022
Name:SQUIRE, DENISE L (PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:L
Last Name:SQUIRE
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 1:720 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5349
Mailing Address - Country:US
Mailing Address - Phone:931-553-8500
Mailing Address - Fax:
Practice Address - Street 1:556 FIRE STATION RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4072
Practice Address - Country:US
Practice Address - Phone:931-553-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1062103TC0700X
TNP2410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4099228OtherBLUE CROSS BLUE SHIELD
TN737644000OtherMAGELLAN BEHAVIORAL
TN1515155Medicaid
TN1515155Medicaid