Provider Demographics
NPI:1770021487
Name:MCNUTT, TERA RENEE (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:TERA
Middle Name:RENEE
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TERA
Other - Middle Name:RENEE
Other - Last Name:WALLPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:614-844-5433
Mailing Address - Fax:614-547-8044
Practice Address - Street 1:6660 DOUBLETREE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1128
Practice Address - Country:US
Practice Address - Phone:614-844-5433
Practice Address - Fax:614-547-8044
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-18-33739103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst