Provider Demographics
NPI:1811385024
Name:AUTISM BRIDGES BEHAVIOR CONSULTING
Entity Type:Organization
Organization Name:AUTISM BRIDGES BEHAVIOR CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:615-557-4405
Mailing Address - Street 1:5901 OLD HICKORY BLVD
Mailing Address - Street 2:APT 1005
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2942
Mailing Address - Country:US
Mailing Address - Phone:615-557-4405
Mailing Address - Fax:866-541-2656
Practice Address - Street 1:5901 OLD HICKORY BLVD
Practice Address - Street 2:APT 1005
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2942
Practice Address - Country:US
Practice Address - Phone:615-557-4405
Practice Address - Fax:866-541-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1502523Medicaid