MEDICARE: COURTNEY BEAVERS

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	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1659192508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY BEAVERS

Provider Business Mailing Address
First Line	:	356 GARDNERS RD
Second Line	:
City	:	MINERAL
State	:	VA
Zip	:	23117-2921
Country	:	US
Telephone Number	:	804-338-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	12201 GAYTON RD STE 103
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-8203
Country	:	US
Telephone Number	:	804-610-2332
Fax Number	:

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

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	02/18/2025

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Directions to “ COURTNEY BEAVERS ” Practice Location

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