Provider Demographics
NPI:1598441636
Name:NALLY, TARAH (BCBA)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:NALLY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 GENERAL GEORGE PATTON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2904
Mailing Address - Country:US
Mailing Address - Phone:615-288-5669
Mailing Address - Fax:855-940-1248
Practice Address - Street 1:1710 GENERAL GEORGE PATTON DR STE 103
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2904
Practice Address - Country:US
Practice Address - Phone:615-288-5669
Practice Address - Fax:855-940-1248
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-23-66114103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst