Healthcare Provider Details

I. General information

NPI: 1275129629
Provider Name (Legal Business Name): CARMEN HUGHES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 AMETHYST WAY
STOCKBRIDGE GA
30281-2530
US

IV. Provider business mailing address

520 AMETHYST WAY
STOCKBRIDGE GA
30281-2530
US

V. Phone/Fax

Practice location:
  • Phone: 816-210-3127
  • Fax: 816-210-3127
Mailing address:
  • Phone: 816-210-3127
  • Fax: 470-491-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50679
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: