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General NPI Number Information
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NPI Number | 1831634617
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Entity Type | Organization
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Legal Business Name | COMMON GROUND COOPERATIVE
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 2309 SCOTT AVE
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City | NASHVILLE
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State | TN
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Zip | 37216-3119
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Country | US
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Telephone | 615-431-3763
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Fax |
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Provider Business Mailing Address
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Address Line | 2309 SCOTT AVE
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City | NASHVILLE
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State | TN
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Zip | 37216-3119
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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 | EXECUTIVE DIRECTOR
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Name | MRS. HEIDI SNOW-WITZEMAN
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Credential | BCBA
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Telephone | 615-431-3763
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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 | 11219240
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License Number State | TN
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