Provider Demographics
NPI:1598130874
Name:YATES, TANDRA SHANICE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TANDRA
Middle Name:SHANICE
Last Name:YATES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 BRISTOL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4289
Mailing Address - Country:US
Mailing Address - Phone:901-292-5765
Mailing Address - Fax:901-624-5292
Practice Address - Street 1:7119 BRISTOL MEADOW LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4289
Practice Address - Country:US
Practice Address - Phone:901-292-5765
Practice Address - Fax:901-624-5292
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-14-9836103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst