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General NPI Number Information
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NPI Number | 1689187247
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Entity Type | Organization
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Legal Business Name | MOBILE THERAPY CENTERS OF TENNESSEE, LLC
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 330 FRANKLIN RD STE 135A-142
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City | BRENTWOOD
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State | TN
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Zip | 37027-3280
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Country | US
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Telephone | 615-478-6603
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Fax |
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Provider Business Mailing Address
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Address Line | 330 FRANKLIN RD STE 135A-142
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City | BRENTWOOD
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State | TN
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Zip | 37027-3280
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Country | US
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Telephone | 615-478-6603
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARRELL G VANZANT JR.
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Credential | BCBA
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Telephone | 615-478-6603
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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 | 11519477
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License Number State | CO
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