Healthcare Provider Details

I. General information

NPI: 1710450564
Provider Name (Legal Business Name): TAMMY LYNN DAVIS BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 OLD CHATTANOOGA PIKE SW
CLEVELAND TN
37311-8566
US

IV. Provider business mailing address

150 KING ARTHUR CT NW
CLEVELAND TN
37312-7106
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-5268
  • Fax:
Mailing address:
  • Phone: 423-303-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: