Provider Demographics
NPI:1790285492
Name:SOUTHEAST BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:SOUTHEAST BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SZALA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:658-312-8220
Mailing Address - Street 1:2230 NORA MAE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2736
Mailing Address - Country:US
Mailing Address - Phone:813-598-1337
Mailing Address - Fax:
Practice Address - Street 1:2230 NORA MAE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2736
Practice Address - Country:US
Practice Address - Phone:813-598-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty