MEDICARE: MICHELLE LYNNE WINTRICH 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	RBT-18-67775	NC
2	103K00000X	Behavior Analyst	12152347	TX

General Provider Information

NPI Number	:	1427607506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNNE WINTRICH BCBA

Provider Business Mailing Address
First Line	:	200 CAHABA PARK CIR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 ELDORADO PKWY STE 106
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-7438
Country	:	US
Telephone Number	:	214-778-1153
Fax Number	:	214-778-1153

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	07/12/2024

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