Provider Demographics
NPI:1023305182
Name:LITTLETON, EDWARD (BCBA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LITTLETON
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 1:9954 BROMPTON DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5418
Mailing Address - Country:US
Mailing Address - Phone:770-827-5055
Mailing Address - Fax:
Practice Address - Street 1:6916 W LINEBAUGH AVE
Practice Address - Street 2:#102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5815
Practice Address - Country:US
Practice Address - Phone:813-265-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3860103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst