Provider Demographics
NPI:1043943160
Name:NEEDHAM, ASHTON (RBT)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 BAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38002-7441
Mailing Address - Country:US
Mailing Address - Phone:901-379-8827
Mailing Address - Fax:
Practice Address - Street 1:8760 BAYLOR RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38002-7441
Practice Address - Country:US
Practice Address - Phone:901-379-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRBT-21-176202OtherRBT