MEDICARE: COURTNEY BROOKE WRIGHT B.C.B.A.

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

General Provider Information

NPI Number	:	1174943088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY BROOKE WRIGHT B.C.B.A.

Provider Business Mailing Address
First Line	:	1516 E PALM VALLEY BLVD
Second Line	:	BLDG. A
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4619
Country	:	US
Telephone Number	:	512-733-2800
Fax Number	:	512-310-5697

Provider Business Practice Location Address
First Line	:	1516 E PALM VALLEY BLVD
Second Line	:	BLDG. A
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4619
Country	:	US
Telephone Number	:	512-733-2800
Fax Number	:	512-310-5697

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

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	11/03/2014

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