Provider Demographics
NPI:1023615960
Name:BRIMMER, TYLER TRAVIS (MABA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:TRAVIS
Last Name:BRIMMER
Suffix:
Gender:M
Credentials:MABA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:859-317-5985
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:1220 ASHLEY CIRCLE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3980
Practice Address - Country:US
Practice Address - Phone:859-317-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1-24-70510103K00000X
KY0-23-14562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst