Provider Demographics
NPI:1437718327
Name:BAILEY, REBECCA JO (RBT, BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RBT, BCBA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:SITTLOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9038 CROSS PARK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4720
Mailing Address - Country:US
Mailing Address - Phone:865-394-6612
Mailing Address - Fax:865-315-7014
Practice Address - Street 1:9038 CROSS PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4720
Practice Address - Country:US
Practice Address - Phone:865-394-6612
Practice Address - Fax:865-315-7014
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-16-26967106S00000X
TN1-20-43665103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLBA664OtherSTATE OF TN
TN1-20-436665OtherBACB
TNRBT-16-26967OtherBACB