1932932555 NPI number — SOPHIA ANN FORYSTEK BEHAVIOR TECHNICIAN

Table of content: SOPHIA ANN FORYSTEK BEHAVIOR TECHNICIAN (NPI 1932932555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932932555 NPI number — SOPHIA ANN FORYSTEK BEHAVIOR TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORYSTEK
Provider First Name:
SOPHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BEHAVIOR TECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932932555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3021 LILYBELLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARRINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37014-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-895-9722
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 GRASSMERE PARK STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-3671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-326-6578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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