Individual
MICHAEL RYAN DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
3441 FORT CAMPBELL BLVD STE F3, CLARKSVILLE, TN 37042-6684
(931) 449-0063
(931) 896-2737
Mailing address
3441 FORT CAMPBELL BLVD STE F3, CLARKSVILLE, TN 37042-6684
(931) 449-0063
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
RBT-16-17545
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-19-38668
BEHAVIOR ANALYST CERTIFICATION BOARD (BACB)
—
01
—
RBT-16-17545
BACB
TN
Enumeration date
03/05/2018
Last updated
09/25/2019
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