Individual
ETHAN LANE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
177 MOUSE CREEK RD NW, CLEVELAND, TN 37312-3838
(888) 963-2228
Mailing address
2409 GEORGETOWN RD NW, CLEVELAND, TN 37311-3553
(423) 457-1907
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-442247
TN
Other
Enumeration date
06/07/2025
Last updated
05/14/2026
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