Individual
MARY STAUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
9038 CROSS PARK DR STE 105, KNOXVILLE, TN 37923-4720
(865) 394-6612
(865) 315-7014
Mailing address
814 EVOLVE WAY # 3-310, KNOXVILLE, TN 37915-2383
(260) 413-8744
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11520854
—
Other
Enumeration date
04/18/2016
Last updated
08/09/2019
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