Provider Demographics
NPI:1912609892
Name:POSITIVE BEHAVIOR SUPPORT
Entity Type:Organization
Organization Name:POSITIVE BEHAVIOR SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:185-583-2672
Mailing Address - Street 1:1001 MASON TUCKER DR APT I70
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5615
Mailing Address - Country:US
Mailing Address - Phone:424-542-9922
Mailing Address - Fax:
Practice Address - Street 1:2717 EDGE O LAKE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-4054
Practice Address - Country:US
Practice Address - Phone:615-854-7535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty