Provider Demographics
NPI:1689125510
Name:YOUNG, JENNIFER (QASP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:QASP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CHEATHAM DAM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-5033
Mailing Address - Country:US
Mailing Address - Phone:615-545-0864
Mailing Address - Fax:
Practice Address - Street 1:2000 CHEATHAM DAM RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:TN
Practice Address - Zip Code:37036-5033
Practice Address - Country:US
Practice Address - Phone:615-545-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8241106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-15-10623OtherREGISTERED BEHAVIOR TECHNICIAN (RBT) THROUGH BACB
8241OtherQUALIFIED AUTISM SERVICES PROVIDER (QASP) CERTIFICATION THROUGH QABA