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General NPI Number Information
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NPI Number | 1184131633
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Entity Type | Organization
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Legal Business Name | PRACTICAL BEHAVIOR ANALYSIS, LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 2270 THORNTON TAYLOR PKWY STE B
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3669
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Country | US
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Telephone | 954-295-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 2270 THORNTON TAYLOR PKWY STE B
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3669
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Country | US
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Telephone | 615-669-6397
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Fax | 615-992-3933
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. ZACHARY STEVENS
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Credential | MS, LBA, BCBA
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Telephone | 954-295-8448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11
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License Number State | TN
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