Provider Demographics
NPI:1023410891
Name:ABA MEMPHIS
Entity type:Organization
Organization Name:ABA MEMPHIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BRITTAIN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:901-471-7222
Mailing Address - Street 1:136 PLAINVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-1928
Mailing Address - Country:US
Mailing Address - Phone:901-461-7222
Mailing Address - Fax:
Practice Address - Street 1:1687 CORDOVA RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2105
Practice Address - Country:US
Practice Address - Phone:901-461-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health