Provider Demographics
NPI:1104252758
Name:THE MADISON CLINIC FOR BEHAVIOR THERAPY, LLC
Entity type:Organization
Organization Name:THE MADISON CLINIC FOR BEHAVIOR THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:615-865-1066
Mailing Address - Street 1:8000 MADISON BLVD
Mailing Address - Street 2:STE 102-117
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2031
Mailing Address - Country:US
Mailing Address - Phone:615-856-1066
Mailing Address - Fax:
Practice Address - Street 1:8000 MADISON BLVD
Practice Address - Street 2:STE 102-117
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2031
Practice Address - Country:US
Practice Address - Phone:615-856-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency