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General NPI Number Information
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NPI Number | 1215472592
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Entity Type | Individual
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Provider Name | ELIZABETH LANE MCINTOSH MS, LBA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 28 FIELDSTONE DR
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City | PARIS
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State | TN
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Zip | 38242
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Country | US
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Telephone | 731-336-4492
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Fax | 731-407-7058
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Provider Business Mailing Address
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Address Line | 28 FIELDSTONE DR
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City | PARIS
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State | TN
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Zip | 38242
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Country | US
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Telephone | 731-336-4492
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Fax | 731-407-7058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1-16-24387
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License Number State | TN
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