Provider Demographics
NPI:1710509757
Name:WINSLOW, HALEY ALLISON (RBT, LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ALLISON
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:RBT, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8219
Mailing Address - Country:US
Mailing Address - Phone:901-690-5213
Mailing Address - Fax:901-666-8440
Practice Address - Street 1:8500 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7392
Practice Address - Country:US
Practice Address - Phone:901-584-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-19-95196106S00000X
TN946103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1-22-57513OtherBEHAVIOR ANALYST CERTIFICATION BOARD
TN946OtherDEPARTMENT OF HEALTH