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General NPI Number Information
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NPI Number | 1194580373
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Entity Type | Organization
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Legal Business Name | CRUNCHTIME CHILDRENS FITNESS AND DEVELOPMENT CENTER
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 224 EMMETT AVE # 300-400
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City | BOWLING GREEN
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State | KY
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Zip | 42101-3981
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Country | US
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Telephone | 270-938-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 337 STRAWBERRY CT
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City | BOWLING GREEN
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State | KY
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Zip | 42101-5055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXIS BREYAUNA MURRY
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Credential | BCBA
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Telephone | 270-938-3090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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