Provider Demographics
NPI:1710322870
Name:VAN HORN, BROOKE (BCBA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:VAN HORN
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 1:108 40TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4901
Mailing Address - Country:US
Mailing Address - Phone:314-920-5531
Mailing Address - Fax:
Practice Address - Street 1:108 40TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4901
Practice Address - Country:US
Practice Address - Phone:314-920-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-26789OtherBCBA NUMBER