Provider Demographics
NPI:1538568985
Name:JOHN B. AVERITT, PH.D., LICENSED PSYCHOLOGIST
Entity type:Organization
Organization Name:JOHN B. AVERITT, PH.D., LICENSED PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:AVERITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:931-526-2722
Mailing Address - Street 1:100 W 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2448
Mailing Address - Country:US
Mailing Address - Phone:931-526-2722
Mailing Address - Fax:931-526-6478
Practice Address - Street 1:100 W 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2448
Practice Address - Country:US
Practice Address - Phone:931-526-2722
Practice Address - Fax:931-526-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1360261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health