Provider Demographics
NPI:1386127611
Name:NELSON, HANNAH E (RBT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 GREENLAW AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-2509
Mailing Address - Country:US
Mailing Address - Phone:901-361-1135
Mailing Address - Fax:
Practice Address - Street 1:6761 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3867
Practice Address - Country:US
Practice Address - Phone:901-379-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0010673461024609106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician