Provider Demographics
NPI:1558625442
Name:AUTISM FOUNDATION OF TENNESSEE
Entity Type:Organization
Organization Name:AUTISM FOUNDATION OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:I
Authorized Official - Credentials:MED
Authorized Official - Phone:615-376-0034
Mailing Address - Street 1:6515 HOLT RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6903
Mailing Address - Country:US
Mailing Address - Phone:615-376-0034
Mailing Address - Fax:
Practice Address - Street 1:6515 HOLT RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6903
Practice Address - Country:US
Practice Address - Phone:615-376-0034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-11-8722103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty