Provider Demographics
NPI:1205463940
Name:PEASE, TIMOTHY ALEXANDER (BCBA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALEXANDER
Last Name:PEASE
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 1:8002 E 50TH DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3299
Mailing Address - Country:US
Mailing Address - Phone:720-961-3764
Mailing Address - Fax:
Practice Address - Street 1:16610 N BLACK CANYON HWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4036
Practice Address - Country:US
Practice Address - Phone:580-730-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
19108960OtherRBT