Provider Demographics
NPI:1326317066
Name:STEVENS, ZACHARY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 VAL MARIE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2391
Mailing Address - Country:US
Mailing Address - Phone:615-669-6397
Mailing Address - Fax:615-992-3933
Practice Address - Street 1:2520 VAL MARIE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2391
Practice Address - Country:US
Practice Address - Phone:615-669-6397
Practice Address - Fax:615-992-3933
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006469Medicaid