Individual
KEENAN LUSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
146 TIMBER CREEK DR STE 101, CORDOVA, TN 38018-4396
(901) 249-7838
Mailing address
146 TIMBER CREEK DR STE 101, CORDOVA, TN 38018-4396
(901) 249-7838
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245764927
NA
—
Enumeration date
10/05/2015
Last updated
01/02/2020
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