Provider Demographics
NPI:1922532423
Name:FEDEROFF, APRIL
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:FEDEROFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13249 CARR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER POINT
Mailing Address - State:TN
Mailing Address - Zip Code:38582-6025
Mailing Address - Country:US
Mailing Address - Phone:931-201-9222
Mailing Address - Fax:
Practice Address - Street 1:1200 E STAN SCHLUETER LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5481
Practice Address - Country:US
Practice Address - Phone:727-278-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN657103K00000X
TX2753103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst