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General NPI Number Information
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NPI Number | 1326900994
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Entity Type | Individual
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Provider Name | TAKIRA MATTHEWS
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 8090 WALNUT RUN RD
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City | CORDOVA
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State | TN
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Zip | 38018-6362
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Country | US
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Telephone | 901-507-5467
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Fax |
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Provider Business Mailing Address
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Address Line | 4459 CEDAR GLENN DR APT 2
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City | MEMPHIS
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State | TN
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Zip | 38128-5853
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Country | US
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Telephone | 901-507-4367
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Fax |
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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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