Provider Demographics
NPI:1710783485
Name:EIDSON, ELIZABETH BARLOW
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BARLOW
Last Name:EIDSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROSEHILL DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVLLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1614
Mailing Address - Country:US
Mailing Address - Phone:629-462-6043
Mailing Address - Fax:
Practice Address - Street 1:415 ROSEHILL DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVLLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1614
Practice Address - Country:US
Practice Address - Phone:629-462-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst