Provider Demographics
NPI:1285815274
Name:MCCORD, BRANDON ELLLIS (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ELLLIS
Last Name:MCCORD
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12482 MAGNOLIA BEND DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-7046
Mailing Address - Country:US
Mailing Address - Phone:901-497-0384
Mailing Address - Fax:866-823-6014
Practice Address - Street 1:6132 AINSWORTH ST
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3576
Practice Address - Country:US
Practice Address - Phone:901-497-0384
Practice Address - Fax:866-823-6014
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00884Medicaid