Provider Demographics
NPI:1124423439
Name:COLSON, TONYA (MA BCBA/ LBA)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:COLSON
Suffix:
Gender:F
Credentials:MA BCBA/ LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06093-2651
Mailing Address - Country:US
Mailing Address - Phone:508-769-7717
Mailing Address - Fax:
Practice Address - Street 1:232 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1844
Practice Address - Country:US
Practice Address - Phone:413-525-1500
Practice Address - Fax:413-525-1900
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid