Provider Demographics
NPI:1740889534
Name:THOMAS, ALI BENTLEY (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:BENTLEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:ALEGRIA
Other - Middle Name:MERYL
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-633-1007
Mailing Address - Fax:502-633-1007
Practice Address - Street 1:202 FRANKFORT ST STE 103&104
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1000
Practice Address - Country:US
Practice Address - Phone:502-633-1007
Practice Address - Fax:502-805-1511
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-20-132935106S00000X
KY276129103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-22-57870OtherBCBA CERTIFICATE