Provider Demographics
NPI:1831463033
Name:MARTIN, TERESA G (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1853 MADISON STREET
Mailing Address - Street 2:UNIT 8
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:615-614-1868
Mailing Address - Fax:931-919-2191
Practice Address - Street 1:279 CLEAR SKY COURT
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:615-613-1868
Practice Address - Fax:931-919-2191
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1-11-9471103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst