Provider Demographics
NPI:1407561251
Name:YORK, JAYDEN RANDALL (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JAYDEN
Middle Name:RANDALL
Last Name:YORK
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 1:1800 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-2619
Mailing Address - Country:US
Mailing Address - Phone:217-251-6967
Mailing Address - Fax:
Practice Address - Street 1:1050 W JOHNSON DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5508
Practice Address - Country:US
Practice Address - Phone:812-233-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-63515103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst