1174986111 NPI number — KRISTINE ANNE THURSTON M.S., BCBA

Table of content: KRISTINE ANNE THURSTON M.S., BCBA (NPI 1174986111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174986111 NPI number — KRISTINE ANNE THURSTON M.S., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THURSTON
Provider First Name:
KRISTINE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174986111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 SPINDLEWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03062-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-710-6837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 DRUM HILL RD
Provider Second Line Business Practice Location Address:
#124
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-710-6837
Provider Business Practice Location Address Fax Number:
978-710-6941
Provider Enumeration Date:
03/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-16-21665 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-16-21665 . This is a "BEHAVIOR ANALYST CERTIFICATION BOARD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com