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General NPI Number Information
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NPI Number | 1376342642
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Entity Type | Organization
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Legal Business Name | BASELINE ABA THERAPY LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 5796 SHELBY OAKS DR STE 8
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City | MEMPHIS
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State | TN
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Zip | 38134-7333
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Country | US
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Telephone | 901-493-8786
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Fax |
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Provider Business Mailing Address
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Address Line | 6923 RED GUM CV
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City | MEMPHIS
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State | TN
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Zip | 38119-6810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AVON WELDON
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Credential |
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Telephone | 818-653-0186
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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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