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General NPI Number Information
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NPI Number | 1215322466
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Entity Type | Organization
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Legal Business Name | ADVANCE BEYOND AUTISM
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Dates
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Enumeration Date | 04/04/2015
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Last Update Date | 04/04/2015
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Provider Practice Location Address
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Address Line | 311 37TH AVE N
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City | NASHVILLE
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State | TN
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Zip | 37209-3902
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Country | US
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Telephone | 615-415-3517
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Fax |
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Provider Business Mailing Address
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Address Line | 311 37TH AVE N
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City | NASHVILLE
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State | TN
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Zip | 37209-3902
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Country | US
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Telephone | 615-415-3517
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | MRS. KATHRYN MARIE GRAY
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Credential | BCBA
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Telephone | 615-415-3517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-13-14279
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License Number State | TN
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