Provider Demographics
NPI:1245748433
Name:TEMPEST, JASON ANTHONY (RBT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANTHONY
Last Name:TEMPEST
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7195 S GAYLORD ST APT A
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-5506
Mailing Address - Country:US
Mailing Address - Phone:720-262-6535
Mailing Address - Fax:
Practice Address - Street 1:11111 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3106
Practice Address - Country:US
Practice Address - Phone:720-262-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-17-38165106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician