Individual
JACOB PATRICK FAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
3155 N COLLEGE AVE STE 108, FAYETTEVILLE, AR 72703-3500
(479) 957-9121
Mailing address
3155 N COLLEGE AVE STE 108, FAYETTEVILLE, AR 72703-3500
(479) 957-9121
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-53551
AR
106S00000X
Behavior Technician
RBT-19-85301
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BACB495512
BACB ID
AR
Enumeration date
02/13/2020
Last updated
10/05/2021
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