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General NPI Number Information
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NPI Number | 1891072559
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Entity Type | Individual
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Provider Name | KATHLEEN AVENA BLANCO M.S., BCBA, PPSC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 508 MADISON STREET UNIT 3
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City | NASHVILLE
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State | TN
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Zip | 37208
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Country | US
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Telephone | 310-561-2197
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Fax |
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Provider Business Mailing Address
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Address Line | 508 MADISON STREET UNIT 3
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City | NASHVILLE
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State | TN
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Zip | 37208
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Country | US
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Telephone | 310-561-2197
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 101061841
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License Number State | CA
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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 | 1-08-4027
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-08-4027
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-08-4027
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License Number State | TN
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