Provider Demographics
NPI:1457722258
Name:MUSIC CITY BEHAVIOR ANALYSIS
Entity Type:Organization
Organization Name:MUSIC CITY BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-438-5635
Mailing Address - Street 1:1932 WELSENBORO CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3342
Mailing Address - Country:US
Mailing Address - Phone:615-438-5635
Mailing Address - Fax:
Practice Address - Street 1:1932 WELSENBORO CIR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3342
Practice Address - Country:US
Practice Address - Phone:615-438-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health