=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336484229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY HUMAN-GONZALEZ M.ED., BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2012
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1790 APACHE DR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77316-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-527-4649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1790 APACHE DR
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77316-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-527-4649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 2140
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 0133004824
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------