Healthcare Provider Details

I. General information

NPI: 1366270829
Provider Name (Legal Business Name): BRIANNA KOOP BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 GREENFIELD LN
CASTALIAN SPRINGS TN
37031-4751
US

IV. Provider business mailing address

136 HIGHWAY 259
PORTLAND TN
37148-4235
US

V. Phone/Fax

Practice location:
  • Phone: 615-415-3517
  • Fax:
Mailing address:
  • Phone: 507-313-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: