Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-13-14065 | TN |
Y | 103K00000X | Behavior Analyst | 292 | TN |
NPI | 1003129560 |
---|---|
Provider Name | Mrs. Alexis Christian Rand |
First Address | Hermitage, TN 37076-2868 |
Second Address | Hermitage, TN 37076-2868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1532316 | (05) | TN |