Provider Demographics
NPI:1134731821
Name:AUTISM CENTERS OF TENNESSEE
Entity type:Organization
Organization Name:AUTISM CENTERS OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTISM PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:901-567-5361
Mailing Address - Street 1:1466 WOOD TRAIL CIR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6124
Mailing Address - Country:US
Mailing Address - Phone:901-463-0213
Mailing Address - Fax:
Practice Address - Street 1:6685 QUINCE RD STE 120
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8037
Practice Address - Country:US
Practice Address - Phone:901-567-5361
Practice Address - Fax:901-321-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty