Provider Demographics
NPI:1124547963
Name:THOMPSON, TERRY LEE III (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:THOMPSON
Suffix:III
Gender:M
Credentials:MA, BCBA
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Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:21 S PARK BLVD STE 21
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-449-2104
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2019-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
1-17-26156103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-26156OtherBCBA CERTIFICATE