Provider Demographics
NPI:1164769634
Name:VANZANT, DARRELL (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:VANZANT
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 ALDER DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1102
Mailing Address - Country:US
Mailing Address - Phone:615-478-6603
Mailing Address - Fax:
Practice Address - Street 1:903 ALDER DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1102
Practice Address - Country:US
Practice Address - Phone:615-478-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator