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NPI Code Detail

MEDICARE: WAVERLY WEATHERSPOON BCBA, LBA

MEDICARE: WAVERLY WEATHERSPOON BCBA, LBA
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 Analyst1923TN

General Provider Information

NPI Number : 1790361590
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAVERLY WEATHERSPOON BCBA, LBA
Provider Business Mailing Address
First Line : 538 BRANDIES CIR STE 102
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128-8423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 538 BRANDIES CIR STE 102
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128-8423
Country : US
Telephone Number : 615-558-5744
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2021
Last Update Date : 02/18/2026

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Directions to “ WAVERLY WEATHERSPOON BCBA, LBA” Practice Location

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