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General NPI Number Information
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NPI Number | 1790285492
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Entity Type | Organization
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Legal Business Name | SOUTHEAST BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 2230 NORA MAE RD
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City | KNOXVILLE
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State | TN
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Zip | 37932-2736
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Country | US
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Telephone | 813-598-1337
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Fax |
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Provider Business Mailing Address
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Address Line | 2230 NORA MAE RD
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City | KNOXVILLE
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State | TN
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Zip | 37932-2736
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Country | US
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Telephone | 813-598-1337
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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 | CHAD SZALA
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Credential | BCBA
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Telephone | 658-312-8220
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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 | 180
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License Number State | TN
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