Provider Demographics
NPI:1710450564
Name:DAVIS, TAMMY LYNN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 KING ARTHUR CT NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-7106
Mailing Address - Country:US
Mailing Address - Phone:423-303-9955
Mailing Address - Fax:
Practice Address - Street 1:764 OLD CHATTANOOGA PIKE SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-8566
Practice Address - Country:US
Practice Address - Phone:423-472-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103K00000XMedicaid
TNLBA0000000393OtherTENNESSEE DEPARTMENT OF HEALTH, DIVISION OF HEALTH RELATED BOARDS