Provider Demographics
NPI:1679370787
Name:MADISON, LYDIA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:MADISON
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 OVERLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5269
Mailing Address - Country:US
Mailing Address - Phone:615-733-4651
Mailing Address - Fax:
Practice Address - Street 1:9005 OVERLOOK BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5269
Practice Address - Country:US
Practice Address - Phone:615-733-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1786103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst