Healthcare Provider Details

I. General information

NPI: 1982921474
Provider Name (Legal Business Name): BEHAVIORAL DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 WEST AVE
CROSSVILLE TN
38555-4773
US

IV. Provider business mailing address

62 WEST AVE
CROSSVILLE TN
38555-4773
US

V. Phone/Fax

Practice location:
  • Phone: 931-337-0166
  • Fax: 931-484-7378
Mailing address:
  • Phone: 931-337-0166
  • Fax: 931-484-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2544
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2544
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2544
License Number StateTN

VIII. Authorized Official

Name: RONNIE R COX
Title or Position: OWNER
Credential: LPC-MHSP
Phone: 931-337-0166