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General NPI Number Information
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NPI Number | 1194100727
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Entity Type | Organization
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Legal Business Name | LEE UNIVERSITY
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 1120 N OCOEE ST
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City | CLEVELAND
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State | TN
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Zip | 37311-4458
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Country | US
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Telephone | 423-614-8000
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Fax | 423-614-9180
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Provider Business Mailing Address
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Address Line | 1120 N OCOEE ST
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City | CLEVELAND
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State | TN
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Zip | 37311-4458
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Country | US
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Telephone | 423-614-8190
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Fax | 423-614-9180
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Authorized Official
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Title or Position | LUDIC DIRECTOR
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Name | DR. TAMARA JOHNSON
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Credential | ED.D., BCBA-D
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Telephone | 423-961-3785
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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 | 1-08-4396
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License Number State | TN
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