MEDICARE: CRISTINA AUTRY

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1033622634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA AUTRY

Provider Business Mailing Address
First Line	:	2919 BREEZEWOOD AVE STE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5283
Country	:	US
Telephone Number	:	910-484-1711
Fax Number	:	910-869-1685

Provider Business Practice Location Address
First Line	:	2919 BREEZEWOOD AVE STE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5283
Country	:	US
Telephone Number	:	910-484-1711
Fax Number	:

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

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	12/11/2020

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Directions to “ CRISTINA AUTRY ” Practice Location

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