Individual
MR. KIERAN MICHAEL POTTERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9038 CROSS PARK DR STE 105, KNOXVILLE, TN 37923-4729
(865) 394-6612
(865) 315-7014
Mailing address
3329 GRASSY POINTE LN, KNOXVILLE, TN 37931-3698
(865) 313-6785
(865) 315-7014
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA0000000188
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-18-30560
BOARD CERTIFIED BEHAVIOR ANALYST
—
01
—
LBA0000000188
LICENSED BEHAVIOR ANALYST
TN
Enumeration date
07/09/2018
Last updated
11/06/2020
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