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General NPI Number Information
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NPI Number | 1265674907
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Entity Type | Individual
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Provider Name | BRANDI N AXT
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Gender | Female
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 502 HIGHWAY 70 STE 273
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City | PEGRAM
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State | TN
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Zip | 37143-2115
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Country | US
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Telephone | 615-497-7428
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Fax | 615-679-3997
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Provider Business Mailing Address
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Address Line | PO BOX 273
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City | PEGRAM
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State | TN
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Zip | 37143-0273
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Country | US
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Telephone | 615-497-7428
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Fax | 615-679-3997
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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 |
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License Number State |
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