Provider Demographics
NPI:1952920001
Name:THE CONNER GROUP FOR PEDIATRIC THERAPIES, LLC
Entity Type:Organization
Organization Name:THE CONNER GROUP FOR PEDIATRIC THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:229-319-8910
Mailing Address - Street 1:218 CENTRAL AVE N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4345
Mailing Address - Country:US
Mailing Address - Phone:229-396-5596
Mailing Address - Fax:229-396-4971
Practice Address - Street 1:218 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4345
Practice Address - Country:US
Practice Address - Phone:229-396-5596
Practice Address - Fax:229-396-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty