Provider Demographics
NPI:1598273674
Name:COAPSTICK, TREVOR (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:COAPSTICK
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 SOUTH PINE STREET
Mailing Address - Street 2:505
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:253-292-4354
Mailing Address - Fax:
Practice Address - Street 1:1307 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5133
Practice Address - Country:US
Practice Address - Phone:360-930-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61084067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst