Godbolt, Qusayy M

Godbolt, Qusayy M is an sole proprietor health care provider with primary practice located at 1207 Snowball Ln , Clarksville TN 37042-7855. He recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as his primary health care specialty. Godbolt, Qusayy M can be contacted via phone (931) 378-4751.

Contact Information

Primary practice address
1207 Snowball Ln Clarksville TN 37042-7855
Phone: (931) 378-4751
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-09-5273 Kentucky
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-09-5273 Tennessee
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-09-5273 Missouri
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-09-5273 Florida
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-09-5273

Profile Details

NPI number 1740504398
LBN Legal business name Godbolt, Qusayy M
Credentials PH.D, BCBA-D
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 24th, 2010
Last updated Mar 20th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740504398 NPPES
Tennessee MEDICAID Q024708
Tennessee MEDICAID 7100405480

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