Provider Demographics
NPI:1013373083
Name:STUCKER, THREASE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:THREASE
Middle Name:
Last Name:STUCKER
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MACK WALTERS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1789
Mailing Address - Country:US
Mailing Address - Phone:502-437-0640
Mailing Address - Fax:
Practice Address - Street 1:26 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1745
Practice Address - Country:US
Practice Address - Phone:502-437-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164976103K00000X
KYAN00211222103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst