Provider Demographics
NPI:1669910907
Name:CONNELL, SHERRY DENISE (BCBA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:DENISE
Last Name:CONNELL
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:GLEASON
Mailing Address - State:TN
Mailing Address - Zip Code:38229-0105
Mailing Address - Country:US
Mailing Address - Phone:731-514-6601
Mailing Address - Fax:731-881-7933
Practice Address - Street 1:145 BETHEL COURT
Practice Address - Street 2:BETHEL AUTISM INSTITUTE
Practice Address - City:MCKENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201
Practice Address - Country:US
Practice Address - Phone:731-514-6601
Practice Address - Fax:731-881-7933
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-07-3348103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst