Provider Demographics
NPI:1114553682
Name:COMPREHENSIVE BEHAVIORAL CONCEPTS
Entity Type:Organization
Organization Name:COMPREHENSIVE BEHAVIORAL CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LBA, BCABA
Authorized Official - Phone:901-901-5544
Mailing Address - Street 1:450 N ERICSON RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4099
Mailing Address - Country:US
Mailing Address - Phone:901-907-5544
Mailing Address - Fax:
Practice Address - Street 1:450 N ERICSON RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4099
Practice Address - Country:US
Practice Address - Phone:901-907-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ047041Medicaid
TN14378708OtherCAQH