MEDICARE: CHRISTIAN CHANDLER MAYBREY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1003779919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN CHANDLER MAYBREY

Provider Business Mailing Address
First Line	:	5633 GROVE COVE DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-8344
Country	:	US
Telephone Number	:	469-200-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	5633 GROVE COVE DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-8344
Country	:	US
Telephone Number	:	469-200-0144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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