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General NPI Number Information
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NPI Number | 1568081545
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Entity Type | Individual
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Provider Name | MARVIN TIMOTHY BLUE JR. BCBA
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Gender | Male
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 300 PEACHTREE ST NE STE CS2
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City | ATLANTA
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State | GA
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Zip | 30308-3565
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Country | US
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Telephone | 678-855-6388
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 ROSWELL RD NW APT F3
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City | ATLANTA
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State | GA
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Zip | 30305-1219
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Country | US
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Telephone | 678-815-5277
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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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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