Provider Demographics
NPI:1558760520
Name:ADAMS, THERESA (BCBA, LBS)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BCBA, LBS
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:EVERSOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6660 SHERMANS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17047-9168
Mailing Address - Country:US
Mailing Address - Phone:717-536-0056
Mailing Address - Fax:
Practice Address - Street 1:6660 SHERMANS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17047-9168
Practice Address - Country:US
Practice Address - Phone:717-536-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001886103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst