Provider Demographics
NPI:1538830542
Name:MCKINNEY-HAGEWOOD, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MCKINNEY-HAGEWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:NADINE
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1210 LOUISVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3613
Mailing Address - Country:US
Mailing Address - Phone:615-602-0427
Mailing Address - Fax:
Practice Address - Street 1:1210 LOUISVILLE HWY
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3613
Practice Address - Country:US
Practice Address - Phone:615-602-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist