| Lee University Developmental Inclusion Classrooms (ludic) | |
|
1120 N Ocoee St Cleveland TN 37311-4458 | |
| (423) 614-8000 | |
| (423) 614-9180 |
| Full Name | Lee University Developmental Inclusion Classrooms (ludic) |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1120 N Ocoee St, Cleveland, Tennessee |
| Authorized Official Name and Position | Tamara Johnson (LUDIC DIRECTOR) |
| Authorized Official Contact | 4239613785 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee University Developmental Inclusion Classrooms (ludic) 1120 N Ocoee St Cleveland TN 37311-4458 Ph: (423) 614-8190 | Lee University Developmental Inclusion Classrooms (ludic) 1120 N Ocoee St Cleveland TN 37311-4458 Ph: (423) 614-8000 |
| NPI Number | 1194100727 |
|---|---|
| Provider Enumeration Date | 07/24/2015 |
| Last Update Date | 07/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194100727 | NPI | - | NPPES |
| PENDING | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-08-4396 (Tennessee) | Primary |
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