Provider Demographics
NPI:1023784311
Name:THOMPSON, CUTLASS (RBT)
Entity type:Individual
Prefix:
First Name:CUTLASS
Middle Name:
Last Name:THOMPSON
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 1:400 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3024
Mailing Address - Country:US
Mailing Address - Phone:501-613-0385
Mailing Address - Fax:
Practice Address - Street 1:400 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3024
Practice Address - Country:US
Practice Address - Phone:501-613-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-180109106S00000X
ARRBT-21-180109106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician