Individual
KATHLEEN AVENA BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, PPSC
Contact information
Practice address
508 MADISON STREET UNIT 3, NASHVILLE, TN 37208
(310) 561-2197
Mailing address
508 MADISON STREET UNIT 3, NASHVILLE, TN 37208
(310) 561-2197
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
101061841
CA
103K00000X
Behavior Analyst
1-08-4027
CA
103K00000X
Behavior Analyst
1-08-4027
MI
103K00000X
Behavior Analyst
Primary
1-08-4027
TN
Other
Enumeration date
11/09/2011
Last updated
10/14/2014
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