MEDICARE: BRIAN BORING M.S. BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	APPLICANT	AZ

General Provider Information

NPI Number	:	1144192345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN BORING M.S. BCBA

Provider Business Mailing Address
First Line	:	13185 E LARREA LN
Second Line	:
City	:	FLORENCE
State	:	AZ
Zip	:	85132-7749
Country	:	US
Telephone Number	:	772-480-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	37200 N GANTZEL RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-7368
Country	:	US
Telephone Number	:	520-484-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	05/25/2026

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