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General NPI Number Information
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NPI Number | 1740889823
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Entity Type | Organization
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Legal Business Name | INFINITE CHANGES ABA THERAPY & AUTISM SERVICES
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 5115 COVINGTON WAY STE 5
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City | MEMPHIS
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State | TN
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Zip | 38134-5619
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Country | US
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Telephone | 901-606-5038
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Fax |
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Provider Business Mailing Address
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Address Line | 8481 REGAL BEND DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-4416
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Country | US
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Telephone | 901-606-5038
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | FREDRICCA BROCK
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Credential | BCBA, LBA
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Telephone | 901-606-5038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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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