Individual
MRS. TRACY LEANE PALM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., B.C.B.A, LBA
Contact information
Practice address
6761 STAGE RD, BARTLETT, TN 38134-3867
(901) 379-8827
(901) 244-6153
Mailing address
4703 OAK RD, BARTLETT, TN 38002-9742
(901) 586-5333
(901) 504-3040
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA0000000266
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205510099
IRS
—
Enumeration date
04/11/2007
Last updated
11/20/2023
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