Provider Demographics
NPI:1760972202
Name:SPECIALIZED BEHAVIOR SOLUTIONS
Entity Type:Organization
Organization Name:SPECIALIZED BEHAVIOR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:423-902-8137
Mailing Address - Street 1:360 LOONEYS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WHITWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37397
Mailing Address - Country:US
Mailing Address - Phone:423-902-8137
Mailing Address - Fax:
Practice Address - Street 1:360 LOONEYS CREEK DR
Practice Address - Street 2:
Practice Address - City:WHITWELL
Practice Address - State:TN
Practice Address - Zip Code:37397
Practice Address - Country:US
Practice Address - Phone:423-902-8137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLBA0000000169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034752Medicaid