Provider Demographics
NPI:1356859151
Name:DOUGLAS, EMILIE (BCBA)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:CONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:9038 CROSS PARK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4720
Mailing Address - Country:US
Mailing Address - Phone:865-983-1899
Mailing Address - Fax:865-315-7014
Practice Address - Street 1:9038 CROSS PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4720
Practice Address - Country:US
Practice Address - Phone:865-983-1899
Practice Address - Fax:865-315-7014
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-17-33554106S00000X
TNLBA627103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician