Provider Demographics
NPI:1043895162
Name:GOFORTH, BRANDI (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:SEERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1726 FORRESTER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-8933
Mailing Address - Country:US
Mailing Address - Phone:317-525-4084
Mailing Address - Fax:
Practice Address - Street 1:1726 FORRESTER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-8933
Practice Address - Country:US
Practice Address - Phone:317-525-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLBA742103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1-21-46965OtherBACB