Provider Demographics
NPI:1679270011
Name:THOMAS, JODY ELAINE (RBT)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:ELAINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WALNUT HALL DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8641
Mailing Address - Country:US
Mailing Address - Phone:859-663-8064
Mailing Address - Fax:
Practice Address - Street 1:3580 HARGRAVE CT
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-6900
Practice Address - Country:US
Practice Address - Phone:859-788-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22-217033106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician