Healthcare Provider Details

I. General information

NPI: 1396017372
Provider Name (Legal Business Name): ACTUAL BEHAVIOR CHANGE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 WHITE BRIDGE RD STE. 103-232
NASHVILLE TN
37205-1444
US

IV. Provider business mailing address

73 WHITE BRIDGE RD STE. 103-232
NASHVILLE TN
37205-1444
US

V. Phone/Fax

Practice location:
  • Phone: 615-916-0664
  • Fax: 615-953-2949
Mailing address:
  • Phone: 615-916-0664
  • Fax: 615-953-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BETHANY HOLTON
Title or Position: OWNER
Credential: LBA, BCBA, MS
Phone: 615-916-0664