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General NPI Number Information
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NPI Number | 1285266924
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Entity Type | Individual
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Provider Name | THERESA A BLANKENSHIP BCABA, LABA
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Gender | Female
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 9038 CROSS PARK DR STE 105
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City | KNOXVILLE
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State | TN
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Zip | 37923-4720
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Country | US
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Telephone | 865-394-6612
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Fax | 865-315-7014
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Provider Business Mailing Address
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Address Line | 9038 CROSS PARK DR STE 105
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City | KNOXVILLE
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State | TN
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Zip | 37923-4720
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Country | US
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Telephone | 865-394-6612
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Fax | 865-315-7014
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-111054
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | LABA36
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License Number State | TN
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