Basic Information
| Provider Information | |||||||||
| NPI: | 1417522384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 HICKORY BARK LN | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372118585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158790223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5511 EDMONDSON PIKE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372115870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156544984 | ||||||||
| FaxNumber: | 8336450881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2021 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 795 | TN | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.