=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437394640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE NEAL M.S., BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2008
-----------------------------------------------------
Last Update Date | 09/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 182 JAGUAR DR
-----------------------------------------------------
City | INWOOD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25428-3180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-433-8493
-----------------------------------------------------
Fax | 888-315-5319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 JAGUAR DR
-----------------------------------------------------
City | INWOOD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25428-3180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-433-8493
-----------------------------------------------------
Fax | 888-315-5319
-----------------------------------------------------
=====================================================
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 | 1/4/1970
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-04-1970
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-04-1970
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------