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NPI Code Detail

MEDICARE: COURTNEY WOLFF BCBA, LBA

MEDICARE: COURTNEY WOLFF BCBA, LBA
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
1103K00000XBehavior Analyst0133000610VA
2103K00000XBehavior Analyst1-15-18461CA

General Provider Information

NPI Number : 1184803199
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY WOLFF BCBA, LBA
Provider Business Mailing Address
First Line : 16782 VON KARMAN AVE STE 11
Second Line :
City : IRVINE
State : CA
Zip : 92606-2417
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 2453 GRAND CANAL BLVD STE A
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8138
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2007
Last Update Date : 03/22/2023

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