Provider Demographics
NPI:1225586340
Name:MAEWEATHER, THESSALIAN (BA, MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:THESSALIAN
Middle Name:
Last Name:MAEWEATHER
Suffix:
Gender:M
Credentials:BA, 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 1:724 ESAU AVE
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6666
Mailing Address - Country:US
Mailing Address - Phone:318-572-8348
Mailing Address - Fax:
Practice Address - Street 1:724 ESAU AVE
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-6666
Practice Address - Country:US
Practice Address - Phone:318-572-8348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-18
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-24-71879103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst