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General NPI Number Information
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NPI Number | 1649783580
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Entity Type | Organization
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Legal Business Name | PHILLIPS ABA THERAPY, LLC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 112 SOUTHRIDGE DR
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-4876
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Country | US
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Telephone | 276-494-2178
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Fax |
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Provider Business Mailing Address
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Address Line | 112 SOUTHRIDGE DR
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-4876
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Country | US
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Telephone | 276-494-2178
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Fax |
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Authorized Official
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Title or Position | OWNER/BCBA
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Name | MRS. REBECCA ANN PHILLIPS
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Credential | BCBA, LBA
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Telephone | 276-494-2178
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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 | 1-16-21866
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License Number State | VA
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