Healthcare Provider Details

I. General information

NPI: 1801377031
Provider Name (Legal Business Name): EMILY TAYLOR FONDREN MS BCBA LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 CALHOUN STATION PKWY
GLUCKSTADT MS
39110-5540
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 601-844-3673
  • Fax:
Mailing address:
  • Phone: 269-414-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number241032
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: