Provider Demographics
NPI:1386377646
Name:LITTLE, JASON DANIEL (BCBA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:LITTLE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-9367
Mailing Address - Country:US
Mailing Address - Phone:304-412-7374
Mailing Address - Fax:
Practice Address - Street 1:10 PRINCE GEORGE CT
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9405
Practice Address - Country:US
Practice Address - Phone:304-412-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst