MEDICARE: COMMON THREAD ABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1144857764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMON THREAD ABA LLC

Provider Business Mailing Address
First Line	:	2004 AMERICAN WAY STE 109
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-5892
Country	:	US
Telephone Number	:	423-612-8469
Fax Number	:	833-540-3751

Provider Business Practice Location Address
First Line	:	2004 AMERICAN WAY STE 109
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-5892
Country	:	US
Telephone Number	:	423-612-8469
Fax Number	:	833-540-3751

Authorized Official
Title or Position	:	COO
Name	:	TIMOTHY STORY
Credential	:
Telephone Number	:	423-612-8469

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/26/2024

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Directions to “COMMON THREAD ABA LLC ” Practice Location

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