Provider Demographics
NPI:1750162228
Name:QUALLS, TOBY KUGAR (MA, BCBA)
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:KUGAR
Last Name:QUALLS
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N MASON ST APT 401
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4411
Mailing Address - Country:US
Mailing Address - Phone:760-914-3411
Mailing Address - Fax:
Practice Address - Street 1:311 N MASON ST APT 401
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4411
Practice Address - Country:US
Practice Address - Phone:760-914-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1-23-68308103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst