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General NPI Number Information
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NPI Number | 1467680843
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Entity Type | Individual
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Provider Name | JASON LINVILLE MA
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Gender | Male
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 550 S ADAMS ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2165
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Country | US
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Telephone | 812-333-6324
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Fax | 812-331-6700
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Provider Business Mailing Address
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Address Line | 3014 OZARK CIR
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City | CHATTANOOGA
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State | TN
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Zip | 37415-5104
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Country | US
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Telephone | 812-360-1776
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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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