Provider Demographics
NPI:1255397261
Name:AVERY, SARAH (SALLY) (PSYD)
Entity type:Individual
Prefix:DR
First Name:SARAH (SALLY)
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E DIVISION RD STE 10
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6908
Mailing Address - Country:US
Mailing Address - Phone:865-482-7782
Mailing Address - Fax:865-482-9488
Practice Address - Street 1:150 E DIVISION RD STE 10
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6908
Practice Address - Country:US
Practice Address - Phone:865-250-7782
Practice Address - Fax:865-482-9488
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3681866Medicaid
TN3681866Medicaid