Provider Demographics
NPI:1750953030
Name:MINTON, CODY ALEXANDER (RBT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:ALEXANDER
Last Name:MINTON
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 1:1034 WOODVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3126
Mailing Address - Country:US
Mailing Address - Phone:865-214-7914
Mailing Address - Fax:
Practice Address - Street 1:120 HUXLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3188
Practice Address - Country:US
Practice Address - Phone:865-399-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-21-176166106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN85-1224409Medicaid