Provider Demographics
NPI:1235713272
Name:STOCKEBRAND, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STOCKEBRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1321 MURFREESBORO PIKE STE 410
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2665
Mailing Address - Country:US
Mailing Address - Phone:615-247-5487
Mailing Address - Fax:615-815-1946
Practice Address - Street 1:1345 COMPANION CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1749
Practice Address - Country:US
Practice Address - Phone:803-905-5107
Practice Address - Fax:615-815-1946
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
SC1-23-66224103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician