Provider Demographics
NPI:1255881066
Name:HALES, THOMAS MARK (MED, BCBA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MARK
Last Name:HALES
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Gender:M
Credentials:MED, BCBA
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Mailing Address - Street 1:4893 EAST BELTLINE AVE NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-901-5478
Mailing Address - Fax:616-591-3393
Practice Address - Street 1:4893 EAST BELTLINE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-901-5478
Practice Address - Fax:166-591-3393
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2022-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI1-16-23859103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst