Provider Demographics
NPI:1245694058
Name:TRIBBLE, THOMAS DAN (RBT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DAN
Last Name:TRIBBLE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-5720
Mailing Address - Country:US
Mailing Address - Phone:817-939-8972
Mailing Address - Fax:
Practice Address - Street 1:10101 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-5720
Practice Address - Country:US
Practice Address - Phone:817-939-8972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-15-08738103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst