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MS. LAURA FORKUM PHD, BCBA-D

Behavioral Analyst

Chattanooga, Tennessee

Provider NPI: 1336398056

Provider Information:
MS. LAURA  FORKUM PHD, BCBA-D
Gender: F
Not Sole Proprietor

Practice Location:
3131 QUIET CREEK TRL  CHATTANOOGA, TN 37406 US
Tel: 423-664-0901  Fax: 423-602-9710

Business Mailing Address:
3131 QUIET CREEK TRL  CHATTANOOGA, TN 37406 US
Tel: 423-664-0901  Fax: 423-602-9710

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103K00000X


Other Provider Identifiers:

IssuerNumberStateType
1508054TN05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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