MEDICARE: COURTNEY ALISHAHI BCBA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215584453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ALISHAHI BCBA

Provider Business Mailing Address
First Line	:	11651 NAVARRO WAY APT 1803
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2743
Country	:	US
Telephone Number	:	574-612-7422
Fax Number	:

Provider Business Practice Location Address
First Line	:	11651 NAVARRO WAY APT 1803
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2743
Country	:	US
Telephone Number	:	574-612-7422
Fax Number	:

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

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	09/04/2023

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