Provider Demographics
NPI:1689285686
Name:BADY, JASMINE (RBT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BADY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9397 BRIGSTOCK CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2384
Mailing Address - Country:US
Mailing Address - Phone:901-691-3653
Mailing Address - Fax:
Practice Address - Street 1:146 TIMBER CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4396
Practice Address - Country:US
Practice Address - Phone:651-341-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-20-114998106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician