Provider Demographics
NPI:1023852597
Name:HATHAWAY, KENT THOMAS (BCBA)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:THOMAS
Last Name:HATHAWAY
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 1:4446 BLACKTHORN DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0912
Mailing Address - Country:US
Mailing Address - Phone:405-413-6364
Mailing Address - Fax:
Practice Address - Street 1:8007 NW 122ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-3302
Practice Address - Country:US
Practice Address - Phone:405-603-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-24-73310103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst