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NPI Code Detail

MEDICARE: THOMAS FUQUA M. ED, BCBA, LBA

MEDICARE: THOMAS FUQUA M. ED, BCBA, LBA
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
1103K00000XBehavior AnalystBA61422369WA

General Provider Information

NPI Number : 1962142257
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS FUQUA M. ED, BCBA, LBA
Provider Business Mailing Address
First Line : 8019 NE 13TH AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-9604
Country : US
Telephone Number : 360-984-3131
Fax Number :
Provider Business Practice Location Address
First Line : 1622 TERMINAL DR
Second Line :
City : RICHLAND
State : WA
Zip : 99354-4953
Country : US
Telephone Number : 360-984-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2022
Last Update Date : 06/12/2024

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