Provider Demographics
NPI:1174986111
Name:THURSTON, KRISTINE ANNE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANNE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SPINDLEWICK DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-4515
Mailing Address - Country:US
Mailing Address - Phone:978-710-6837
Mailing Address - Fax:
Practice Address - Street 1:119 DRUM HILL RD
Practice Address - Street 2:#124
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1505
Practice Address - Country:US
Practice Address - Phone:978-710-6837
Practice Address - Fax:978-710-6941
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-21665103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-16-21665OtherBEHAVIOR ANALYST CERTIFICATION BOARD