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NPI Code Detail

MEDICARE: PHAEDRA ANGLIN BCBA

MEDICARE: PHAEDRA ANGLIN 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
1103K00000XBehavior Analyst2858TX

General Provider Information

NPI Number : 1215325972
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHAEDRA ANGLIN BCBA
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 3760 S MASON RD STE 10
Second Line :
City : KATY
State : TX
Zip : 77450-7729
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2015
Last Update Date : 03/23/2026

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