Provider Demographics
NPI:1053836213
Name:TODD, TOBIN NATHANIAL (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TOBIN
Middle Name:NATHANIAL
Last Name:TODD
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 S 3RD ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-3252
Practice Address - Country:US
Practice Address - Phone:574-359-6796
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst