Provider Demographics
NPI:1740796929
Name:WOODS, REANNE HENIECE (BCBA)
Entity Type:Individual
Prefix:
First Name:REANNE
Middle Name:HENIECE
Last Name:WOODS
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 1:1727 N GERMANTOWN PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3328
Mailing Address - Country:US
Mailing Address - Phone:901-315-7628
Mailing Address - Fax:855-430-0596
Practice Address - Street 1:1727 N GERMANTOWN PKWY STE 107
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3328
Practice Address - Country:US
Practice Address - Phone:901-315-7628
Practice Address - Fax:855-430-0596
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-24
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-17-28516103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ035787Medicaid