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General NPI Number Information
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NPI Number | 1780498212
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Entity Type | Individual
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Provider Name | ELISE DETRUDE BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 2603 WESTWOOD DR
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City | NASHVILLE
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State | TN
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Zip | 37204-2709
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Country | US
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Telephone | 615-703-3531
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CHAMBERLIN ST UNIT C
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City | NASHVILLE
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State | TN
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Zip | 37209-4850
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Country | US
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Telephone |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1757
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License Number State | TN
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