Provider Demographics
NPI:1003381518
Name:THOMAS, KESHIA (BCBA)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 CUMBERLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2253
Mailing Address - Country:US
Mailing Address - Phone:615-669-6397
Mailing Address - Fax:
Practice Address - Street 1:351 CUMBERLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2253
Practice Address - Country:US
Practice Address - Phone:615-669-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033196Medicaid