Provider Demographics
NPI:1144562372
Name:DAVIDSON, MATTHEW ALAN (BCBA, LBA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALAN
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:ALAN
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:150 TIMBER CREEK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4236
Mailing Address - Country:US
Mailing Address - Phone:901-248-0595
Mailing Address - Fax:
Practice Address - Street 1:4055 N PARK LOOP STE 1000
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-4236
Practice Address - Country:US
Practice Address - Phone:901-678-3209
Practice Address - Fax:901-678-5630
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLBA0000000387103K00000X
MS1-13-13263103K00000X
MS160010103K00000X
1-13-13263103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst