Provider Demographics
NPI:1871208942
Name:PRENTISS, ABBY ELIZABETH
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:ELIZABETH
Last Name:PRENTISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 TIMBER CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4396
Mailing Address - Country:US
Mailing Address - Phone:901-654-5693
Mailing Address - Fax:
Practice Address - Street 1:146 TIMBER CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4396
Practice Address - Country:US
Practice Address - Phone:901-654-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN790744106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician