Provider Demographics
NPI:1083176655
Name:MCDANIEL, ANNA LYN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:LYN
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 OLD HUMBOLDT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1752
Mailing Address - Country:US
Mailing Address - Phone:731-668-3888
Mailing Address - Fax:731-668-1666
Practice Address - Street 1:1119 OLD HUMBOLDT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1752
Practice Address - Country:US
Practice Address - Phone:731-668-3888
Practice Address - Fax:731-668-1666
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN459103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1-18-33497OtherBEHAVIOR ANALYST CERTIFICATION BOARD