Provider Demographics
NPI:1700071651
Name:CRIPPS, TIMOTHY (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:CRIPPS
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PEYTON PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7905
Mailing Address - Country:US
Mailing Address - Phone:901-233-1218
Mailing Address - Fax:
Practice Address - Street 1:71 PEYTON PKWY STE 102
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-7905
Practice Address - Country:US
Practice Address - Phone:901-233-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TM1800X
TN86103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517483Medicaid