Provider Demographics
NPI:1346420809
Name:SMITH, JEFFREY BRIAN (EDD, LBA, BCBA-D)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:EDD, LBA, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10385 LOBLOLLY VIEW LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4869
Mailing Address - Country:US
Mailing Address - Phone:901-488-7830
Mailing Address - Fax:901-309-0198
Practice Address - Street 1:4055 N PARK LOOP STE 1000
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-4869
Practice Address - Country:US
Practice Address - Phone:320-990-1678
Practice Address - Fax:901-678-5630
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00010103K00000X
TN1-04-1533103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst