Provider Demographics
NPI:1609113877
Name:WHITE, JANE P (BCBA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:P
Last Name:WHITE
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 1:6323 RIDGE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3476
Mailing Address - Country:US
Mailing Address - Phone:276-698-5609
Mailing Address - Fax:
Practice Address - Street 1:1101 CARTER ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-5017
Practice Address - Country:US
Practice Address - Phone:423-490-7710
Practice Address - Fax:423-490-7750
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TN180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst