Provider Demographics
NPI:1609028133
Name:JOHNSON, TAMARA BILBO (EDD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:BILBO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:EDD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 OLD PARKSVILLE TRL SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-8706
Mailing Address - Country:US
Mailing Address - Phone:423-961-3785
Mailing Address - Fax:423-614-8190
Practice Address - Street 1:352 OLD PARKSVILLE TRL SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-8706
Practice Address - Country:US
Practice Address - Phone:423-961-3785
Practice Address - Fax:423-614-8190
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst