Provider Demographics
NPI:1720458565
Name:MCK BEHAVIOR SERVICES LLC
Entity Type:Organization
Organization Name:MCK BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCBA
Authorized Official - Phone:901-387-0300
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0280
Mailing Address - Country:US
Mailing Address - Phone:901-387-0300
Mailing Address - Fax:901-339-6611
Practice Address - Street 1:2843 STAGE CENTER DR
Practice Address - Street 2:SUITE #3
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4697
Practice Address - Country:US
Practice Address - Phone:901-387-0300
Practice Address - Fax:901-339-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445397Medicaid