Organization
BEHAVIOR, ATTENTION, AND DEVELOPMENTAL DISABILITIES CONSULTANTS, LLC
Active
Other names
Integrated Health
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY THOMAS JOHNSON PH.D. (OWNER)
(662) 609-4950
Entity
Organization
Contact information
Practice address
5779 GETWELL RD BLDG D3, SOUTHAVEN, MS 38672-6351
(662) 510-6507
(662) 510-6508
Mailing address
4628 UNION RD, SARDIS, MS 38666-3280
(662) 609-4950
(844) 445-7727
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00634747
—
MS
05
—
Q055944
—
TN
Enumeration date
12/14/2007
Last updated
02/22/2021
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