Provider Demographics
NPI:1619544756
Name:THOMAS, GENNA (RBT)
Entity Type:Individual
Prefix:
First Name:GENNA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7517
Mailing Address - Country:US
Mailing Address - Phone:317-914-3176
Mailing Address - Fax:844-742-6592
Practice Address - Street 1:1599 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-7517
Practice Address - Country:US
Practice Address - Phone:317-914-3176
Practice Address - Fax:844-742-6592
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IN11621917103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician