Provider Demographics
NPI:1457995649
Name:RUST, TINERA MARIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TINERA
Middle Name:MARIE
Last Name:RUST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 C ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-2832
Mailing Address - Country:US
Mailing Address - Phone:402-617-0219
Mailing Address - Fax:
Practice Address - Street 1:1600 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1568
Practice Address - Country:US
Practice Address - Phone:402-617-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1-19-37262103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty