Healthcare Provider Details

I. General information

NPI: 1689925836
Provider Name (Legal Business Name): MALLORY HOLTER MCLAREN BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALLORY HOLTER CHILSON BCBA

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 DAVIDSON ST
TULLAHOMA TN
37388-3607
US

IV. Provider business mailing address

665 COUNTRY CLUB DR
MANCHESTER TN
37355-3025
US

V. Phone/Fax

Practice location:
  • Phone: 931-393-5900
  • Fax:
Mailing address:
  • Phone: 931-434-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number852
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: