Healthcare Provider Details

I. General information

NPI: 1740198548
Provider Name (Legal Business Name): CARLI GRACE BENTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 S BRUNDIDGE ST
TROY AL
36081-3148
US

IV. Provider business mailing address

1018 S BRUNDIDGE ST
TROY AL
36081-3148
US

V. Phone/Fax

Practice location:
  • Phone: 334-618-3302
  • Fax: 334-460-8468
Mailing address:
  • Phone: 334-618-3302
  • Fax: 334-460-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2840411
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: