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General NPI Number Information
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NPI Number | 1780986182
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Entity Type | Organization
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Legal Business Name | APPLIED BEHAVIORAL DIAGNOSTICS
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 155 CAMERON DR
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City | OAKLAND
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State | TN
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Zip | 38060-3373
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Country | US
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Telephone | 901-338-7463
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Fax | 901-465-9062
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Provider Business Mailing Address
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Address Line | 155 CAMERON DR
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City | OAKLAND
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State | TN
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Zip | 38060-3373
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Country | US
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Telephone | 901-338-7463
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Fax | 901-465-9062
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Authorized Official
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Title or Position | OWNER
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Name | MR. ZACH SHOEMAKER
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Credential | MS, BCBA
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Telephone | 901-338-7463
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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 | 1-09-5345
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License Number State | TN
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