Provider Demographics
NPI:1275923880
Name:MOMENTUM BEHAVIOR ANALYSIS, LLC
Entity Type:Organization
Organization Name:MOMENTUM BEHAVIOR ANALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:931-335-3950
Mailing Address - Street 1:1215 WAR EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38572-9009
Mailing Address - Country:US
Mailing Address - Phone:931-287-3710
Mailing Address - Fax:931-287-2778
Practice Address - Street 1:1215 WAR EAGLE DR
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38572-9009
Practice Address - Country:US
Practice Address - Phone:931-287-3710
Practice Address - Fax:931-287-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ011719Medicaid