Provider Demographics
NPI:1790326106
Name:DENNIS, NATHAN DANIEL (BCBA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:DANIEL
Last Name:DENNIS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7446 SHALLOWFORD RD STE 116
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2352
Mailing Address - Country:US
Mailing Address - Phone:423-314-8818
Mailing Address - Fax:423-805-9889
Practice Address - Street 1:7446 SHALLOWFORD RD STE 116
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2352
Practice Address - Country:US
Practice Address - Phone:423-551-9367
Practice Address - Fax:423-805-9889
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty