Provider Demographics
NPI:1417522384
Name:HENDERSON, ASHLEY L (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:F
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 1:1701 HICKORY BARK LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8585
Mailing Address - Country:US
Mailing Address - Phone:615-879-0223
Mailing Address - Fax:
Practice Address - Street 1:5511 EDMONDSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5870
Practice Address - Country:US
Practice Address - Phone:615-654-4984
Practice Address - Fax:833-645-0881
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN795103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst