Provider Demographics
NPI:1780986182
Name:APPLIED BEHAVIORAL DIAGNOSTICS
Entity type:Organization
Organization Name:APPLIED BEHAVIORAL DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:901-338-7463
Mailing Address - Street 1:155 CAMERON DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-3373
Mailing Address - Country:US
Mailing Address - Phone:901-338-7463
Mailing Address - Fax:901-465-9062
Practice Address - Street 1:155 CAMERON DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-3373
Practice Address - Country:US
Practice Address - Phone:901-338-7463
Practice Address - Fax:901-465-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-09-5345251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517027Medicaid