Provider Demographics
NPI:1235394545
Name:FERRIS, GEOFFREY JOHN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:JOHN
Last Name:FERRIS
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 1:1700 STATE ST
Mailing Address - Street 2:# 403
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2984
Mailing Address - Country:US
Mailing Address - Phone:615-916-0664
Mailing Address - Fax:615-953-2949
Practice Address - Street 1:1700 STATE ST
Practice Address - Street 2:# 403
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2984
Practice Address - Country:US
Practice Address - Phone:615-916-0664
Practice Address - Fax:615-953-2949
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-11-9526103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst