Provider Demographics
NPI:1114349297
Name:POWELL, RICHARD (BCBA-D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 FARMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3307
Mailing Address - Country:US
Mailing Address - Phone:901-485-8970
Mailing Address - Fax:
Practice Address - Street 1:10275 HERONS NEST CV E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-8289
Practice Address - Country:US
Practice Address - Phone:901-485-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-04-2061103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst