Provider Demographics
NPI:1982421822
Name:WELDON, MISTY ADINA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:ADINA
Last Name:WELDON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3872
Mailing Address - Country:US
Mailing Address - Phone:270-584-3109
Mailing Address - Fax:
Practice Address - Street 1:2620 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3872
Practice Address - Country:US
Practice Address - Phone:270-584-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY294469103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst