| Thweatt Advanced Behavior Associates | |
|
708 Broad Ave Gulfport MS 39501-1350 | |
| (731) 614-3101 | |
| (228) 300-2113 |
| Full Name | Thweatt Advanced Behavior Associates |
|---|---|
| Speciality | Behavior Analyst |
| Location | 708 Broad Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Jacqueline Renee Thomas Thweatt-burton (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7316143101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thweatt Advanced Behavior Associates 708 Broad Ave Gulfport MS 39501-1350 Ph: (731) 614-3101 | Thweatt Advanced Behavior Associates 708 Broad Ave Gulfport MS 39501-1350 Ph: (731) 614-3101 |
| NPI Number | 1609507961 |
|---|---|
| Provider Enumeration Date | 06/17/2022 |
| Last Update Date | 07/20/2022 |
| Certification Date | 07/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609507961 | NPI | - | NPPES |
| 0000000623 | Other | TN | TENNESSEE DEPARTMENT OF HEALTH |
| 200005 | Other | MS | MISSISSIPPI AUTISM BOARD |
| 06888361 | Medicaid | MS | |
| LBA0000000627 | Other | AL | ALABAMA BEHAVIOR ANALYST LICENSING BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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