Provider Demographics
NPI:1518359793
Name:TINSLEY, MARY KATHERINE (BCBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 13TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5110
Mailing Address - Country:US
Mailing Address - Phone:425-307-1815
Mailing Address - Fax:
Practice Address - Street 1:11415 NE 128TH ST STE 40
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6315
Practice Address - Country:US
Practice Address - Phone:425-307-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-04-1789OtherBACB