Individual
REBECCA M BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., 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
(931) 896-2737
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-34557
—
106S00000X
Behavior Technician
RBT-17-32693
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-19-34557
BACB
—
01
—
RBT-17-32693
BACB
TN
Enumeration date
03/05/2018
Last updated
03/26/2019
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