Mark Thaxton

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-18-51275 Issued in TN

Practice address

2011 Fort Campbell Blvd Unit 2312
Clarksville, TN 37042-2239

Phone

(615) 519-7799

NPI assigned

Aug 19, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1659047652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 FORT CAMPBELL BLVD UNIT 2312",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370422239",
            "telephone_number": "615-519-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 FORT CAMPBELL BLVD UNIT 2312",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370422239",
            "telephone_number": "615-519-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAXTON",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "TN",
            "license": "RBT-18-51275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RBT",
            "identifier": "RBT-18-51275",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lori@ljbehaviorconsultantsllc.com",
            "affiliation": "N",
            "endpointDescription": "office",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2011 Fort Campbell Blvd Unit 2312",
            "city": "Clarksville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370422239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Technician in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Behavior Technician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.