Provider Demographics
NPI:1790341477
Name:PORTER, BLAIR A (BCBA)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:A
Last Name:PORTER
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 1:810 BELLEVUE RD APT 187
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2734
Mailing Address - Country:US
Mailing Address - Phone:615-636-1206
Mailing Address - Fax:
Practice Address - Street 1:134 BELLE FOREST CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2104
Practice Address - Country:US
Practice Address - Phone:615-636-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst