Organization
MIDSOUTH BEHAVIOR CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ELLIS MCCORD M.S., BCBA (BEHAVIOR ANALYST)
(901) 497-0384
Entity
Organization
Contact information
Practice address
12482 MAGNOLIA BEND DR, ARLINGTON, TN 38002-7046
(901) 497-0384
(866) 823-6014
Mailing address
12482 MAGNOLIA BEND DR, ARLINGTON, TN 38002-7046
(901) 497-0384
(866) 823-6014
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2500733
—
TN
Enumeration date
10/06/2015
Last updated
10/06/2015
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