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General NPI Number Information
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NPI Number | 1548677487
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Entity Type | Organization
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Legal Business Name | BEHAVIOR SERVICES OF THE MID-SOUTH
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 8349 TRINITY RD
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City | CORDOVA
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State | TN
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Zip | 38018-6761
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Country | US
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Telephone | 901-484-3545
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Fax |
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Provider Business Mailing Address
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Address Line | 8349 TRINITY RD
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City | CORDOVA
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State | TN
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Zip | 38018-6761
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Country | US
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Telephone | 901-484-3545
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. SUSAN ELSWICK
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Credential | ED.D, LCSW, LSSW
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Telephone | 901-484-3546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5660
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License Number State | TN
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