Organization
AMAZE BEHAVIOR THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARRIE EILEEN WALLS BCBA (OWNER/CLINICAL DIRECTOR)
(423) 322-8796
Entity
Organization
Contact information
Practice address
3505 ADKISSON DR NW, SUITE 208, CLEVELAND, TN 37312-6803
(423) 322-8796
(423) 473-6721
Mailing address
3505 ADKISSON DR NW, SUITE 208, CLEVELAND, TN 37312-6803
(423) 322-8796
(423) 473-6721
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-12-11707
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528677
—
TN
Enumeration date
09/23/2014
Last updated
09/23/2014
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