Provider Demographics
NPI:1669764858
Name:LEE, JOHANNA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WILSON PIKE CIR
Mailing Address - Street 2:STE 320
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5252
Mailing Address - Country:US
Mailing Address - Phone:615-376-0034
Mailing Address - Fax:
Practice Address - Street 1:500 WILSON PIKE CIR
Practice Address - Street 2:STE 320
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5252
Practice Address - Country:US
Practice Address - Phone:615-376-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-10-6806103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst