Organization
JADED LOTUS ABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOJUAN FULLWILEY (BCBA)
(901) 498-0108
Entity
Organization
Contact information
Practice address
3834 GINKGO LN APT 206, MEMPHIS, TN 38125-6538
(901) 336-4225
Mailing address
3834 GINKGO LN APT 206, MEMPHIS, TN 38125-6538
(901) 336-4225
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14404249
CAQH
—
05
—
Q047274
—
TN
05
—
Q0565582
—
TN
Enumeration date
03/18/2020
Last updated
07/11/2023
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