Individual
TAYLOR ALEXIS LIGHTFOOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6761 STAGE RD, BARTLETT, TN 38134-3867
(901) 379-8827
Mailing address
14287 WINDING VALLEY RD N, BYHALIA, MS 38611-7218
(901) 314-5992
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-28786
TN
Other
Enumeration date
05/03/2018
Last updated
05/03/2018
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