Provider Demographics
NPI:1841046471
Name:EARLEY, ALYSSA JADE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JADE
Last Name:EARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 MEDFORD CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBURO
Mailing Address - State:TN
Mailing Address - Zip Code:37127
Mailing Address - Country:US
Mailing Address - Phone:205-451-5482
Mailing Address - Fax:
Practice Address - Street 1:4005 CEDAR GLADES DRIVE
Practice Address - Street 2:UNIT A
Practice Address - City:MURFREESBURO
Practice Address - State:TN
Practice Address - Zip Code:37128
Practice Address - Country:US
Practice Address - Phone:615-560-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN147538855106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician