Healthcare Provider Details

I. General information

NPI: 1689301434
Provider Name (Legal Business Name): KRISTIN EVELYN CHANCE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN E RAY BCBA

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 SHELBY OAKS DR STE 100
MEMPHIS TN
38134-7318
US

IV. Provider business mailing address

5909 SHELBY OAKS DR STE 100
MEMPHIS TN
38134-7318
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-9193
  • Fax: 901-339-1637
Mailing address:
  • Phone: 901-383-9193
  • Fax: 901-339-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: