Basic Information
| Provider Information | |||||||||
| NPI: | 1598232498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLDEN STEPS ABA TN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 3RD AVE FL 2 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100161919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455965130 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9005 OVERLOOK BLVD | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453232610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2018 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOLMARK | ||||||||
| AuthorizedOfficialFirstName: | YISROEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8455965130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 193200000X MULTI-SPECIALTY GROUP | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.