Healthcare Provider Details

I. General information

NPI: 1619569779
Provider Name (Legal Business Name): ANNA CATE TAYLOR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA ELIZABETH TAYLOR

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11865 WEXFORD CLUB DR
ROSWELL GA
30075-1471
US

IV. Provider business mailing address

11865 WEXFORD CLUB DR
ROSWELL GA
30075-1471
US

V. Phone/Fax

Practice location:
  • Phone: 925-752-2119
  • Fax: 404-481-2699
Mailing address:
  • Phone: 925-752-2119
  • Fax: 404-481-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-63684
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: