Provider Demographics
NPI:1184281545
Name:CARADINE BEHAVIOR CONSULTING INC
Entity type:Organization
Organization Name:CARADINE BEHAVIOR CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALLORIE
Authorized Official - Middle Name:HUTTON
Authorized Official - Last Name:CARADINE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA/LBS
Authorized Official - Phone:901-412-8678
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-1177
Mailing Address - Country:US
Mailing Address - Phone:901-412-8678
Mailing Address - Fax:
Practice Address - Street 1:1821 LOOKING GLASS LN
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-9817
Practice Address - Country:US
Practice Address - Phone:901-412-8678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1487044707Medicaid