Provider Demographics
NPI:1902596950
Name:TABB, AARON THOMAS
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:THOMAS
Last Name:TABB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1931
Mailing Address - Country:US
Mailing Address - Phone:417-438-7890
Mailing Address - Fax:
Practice Address - Street 1:2202 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1931
Practice Address - Country:US
Practice Address - Phone:417-438-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-22-58901103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst