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NPI Code Detail

MEDICARE: CALLIE GRACE JULIAN RBT

MEDICARE: CALLIE GRACE JULIAN RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1114610417
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALLIE GRACE JULIAN RBT
Provider Business Mailing Address
First Line : 1770 S JEFFERSON AVE APT L1
Second Line :
City : COOKEVILLE
State : TN
Zip : 38506-5561
Country : US
Telephone Number : 931-644-7791
Fax Number :
Provider Business Practice Location Address
First Line : 206 S JEFFERSON AVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-4748
Country : US
Telephone Number : 931-283-2919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2023
Last Update Date : 06/01/2023

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