Healthcare Provider Details

I. General information

NPI: 1740889534
Provider Name (Legal Business Name): ALI BENTLEY THOMAS MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEGRIA MERYL BENTLEY

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FRANKFORT ST STE 103&104
VERSAILLES KY
40383-1000
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1007
  • Fax: 502-805-1511
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-633-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number276129
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-132935
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: