MEDICARE: MATEO LUKAS ODEH RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		TN

General Provider Information

NPI Number	:	1548110265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATEO LUKAS ODEH RBT

Provider Business Mailing Address
First Line	:	4825 AZALEA AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1402
Country	:	US
Telephone Number	:	423-829-0452
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 AZALEA AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1402
Country	:	US
Telephone Number	:	423-829-0452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ MATEO LUKAS ODEH RBT” Practice Location

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