Healthcare Provider Details

I. General information

NPI: 1306074638
Provider Name (Legal Business Name): ANDREA HUNTER GAST BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 BLUFF RD
MEMPHIS TN
38117-6228
US

IV. Provider business mailing address

1170 BLUFF RD
MEMPHIS TN
38117-6228
US

V. Phone/Fax

Practice location:
  • Phone: 615-299-6332
  • Fax:
Mailing address:
  • Phone: 615-299-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: