Healthcare Provider Details

I. General information

NPI: 1851814362
Provider Name (Legal Business Name): BRENDA RENEE MCCOY BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 THORNBERRY CT STE 710
MASON OH
45040-7815
US

IV. Provider business mailing address

6396 THORNBERRY CT STE 710
MASON OH
45040-7815
US

V. Phone/Fax

Practice location:
  • Phone: 859-349-2565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-27351
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: