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NPI Code Detail

MEDICARE: MARY HAYMAKER B.C.B.A.

MEDICARE: MARY HAYMAKER B.C.B.A.
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1790230191
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY HAYMAKER B.C.B.A.
Provider Business Mailing Address
First Line : PO BOX 8114
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37414-0114
Country : US
Telephone Number : 423-622-1551
Fax Number :
Provider Business Practice Location Address
First Line : 3074 HICKORY VALLEY RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1273
Country : US
Telephone Number : 423-622-1551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2016
Last Update Date : 08/16/2016

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