Provider Demographics
NPI:1790263945
Name:BUTHELEZI, THULISILE (MS, BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:THULISILE
Middle Name:
Last Name:BUTHELEZI
Suffix:
Gender:F
Credentials:MS, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREAT VALLEY PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1426
Mailing Address - Country:US
Mailing Address - Phone:484-757-5538
Mailing Address - Fax:610-889-9726
Practice Address - Street 1:5 GREAT VALLEY PKWY STE 270
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1426
Practice Address - Country:US
Practice Address - Phone:484-757-5538
Practice Address - Fax:610-889-9726
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-18-57925106S00000X
CO1-20-44472103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician