Jaded Lotus ABA LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

JADED LOTUS ABA LLC

Practice address

3834 Ginkgo LN Apt 206
Memphis, TN 38125-6538

Phone

(901) 336-4225

NPI assigned

Mar 18, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jojuan FullwileyNPI 1417469628

Title

Bcba

Phone

(901) 498-0108

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jojuan Fullwiley, BCBA

  • Behavior Analyst
  • Memphis, TN
  • NPI 1417469628
  NPD Authorized official
• Malorye Smith, RBT

  • Behavior Technician
  • Memphis, TN
  • NPI 1134799448
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1023644366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3834 GINKGO LN APT 206",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381256538",
            "telephone_number": "901-336-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3834 GINKGO LN APT 206",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381256538",
            "telephone_number": "901-336-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JADED LOTUS ABA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-18",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "FULLWILEY",
        "authorized_official_first_name": "JOJUAN",
        "authorized_official_title_or_position": "BCBA",
        "authorized_official_telephone_number": "901-498-0108"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14404249",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q047274",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q0565582",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Jacobson, OT
• Jennifer L. Jacobson, PSY.D.
• George Jacoby, M.A. SLPE
• Lisa M Jacola, PH.D.
• Jacqueline London
• Jaded Lotus Academy
• Frederick John Jaecklein, M.D.
• Jaeco Staffing
• Robin Jaffe, LADAC
• Bhuvaneshwari Jagadesan, M.D.

• Behavior Analyst in Memphis, TN
• Providers in Memphis, TN by specialty
• Behavior Analyst in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.