Provider Demographics
NPI:1689187247
Name:MOBILE THERAPY CENTERS OF TENNESSEE, LLC
Entity Type:Organization
Organization Name:MOBILE THERAPY CENTERS OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:VANZANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCBA
Authorized Official - Phone:615-478-6603
Mailing Address - Street 1:330 FRANKLIN RD STE 135A-142
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3280
Mailing Address - Country:US
Mailing Address - Phone:615-478-6603
Mailing Address - Fax:
Practice Address - Street 1:330 FRANKLIN RD STE 135A-142
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3280
Practice Address - Country:US
Practice Address - Phone:615-478-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11519477103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty