Provider Demographics
NPI:1346748662
Name:BRUIJN, KAYLEE ANN (PHD)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ANN
Last Name:BRUIJN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:DALE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7516 ENTERPRISE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3802
Mailing Address - Country:US
Mailing Address - Phone:901-755-5802
Mailing Address - Fax:901-757-2249
Practice Address - Street 1:7516 ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3802
Practice Address - Country:US
Practice Address - Phone:901-755-5802
Practice Address - Fax:901-757-2249
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3545103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist