Provider Demographics
NPI:1467292755
Name:RENFRO, JORDAN BROOKE (RBT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BROOKE
Last Name:RENFRO
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 1:1107A W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-4204
Mailing Address - Country:US
Mailing Address - Phone:615-362-1084
Mailing Address - Fax:
Practice Address - Street 1:1710 GENERAL GEORGE PATTON DR STE 103
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2904
Practice Address - Country:US
Practice Address - Phone:615-288-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-23-309570103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst