Healthcare Provider Details

I. General information

NPI: 1407286669
Provider Name (Legal Business Name): DEBRA PICKERING MS BCBA LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W PROFESSIONAL PARK CT STE 1
BOWLING GREEN KY
42104-3250
US

IV. Provider business mailing address

PO BOX 51322
BOWLING GREEN KY
42102-5622
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-5300
  • Fax: 270-843-5383
Mailing address:
  • Phone: 270-777-9283
  • Fax: 270-777-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0027
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: