Provider Demographics
NPI:1962813170
Name:TOMLINSON, STEPHEN (BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TOMLINSON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-1000
Mailing Address - Country:US
Mailing Address - Phone:814-241-1809
Mailing Address - Fax:
Practice Address - Street 1:310 NORTH AVE
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1000
Practice Address - Country:US
Practice Address - Phone:814-241-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000907103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1-02-0864OtherBEHAVIOR ANALYST CERTIFICATION BOARD