Provider Demographics
NPI:1699575456
Name:MOODY, BRANDI PAMELA (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:PAMELA
Last Name:MOODY
Suffix:
Gender:
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 E MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-7825
Mailing Address - Country:US
Mailing Address - Phone:865-595-0220
Mailing Address - Fax:
Practice Address - Street 1:2360 BOWSER RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5011
Practice Address - Country:US
Practice Address - Phone:931-529-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician