MEDICARE: SHAUNA COURTNEY 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	1-084834	GA

General Provider Information

NPI Number	:	1225443161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNA COURTNEY BCBA

Provider Business Mailing Address
First Line	:	1000 HOLCOMB WOODS PKWY
Second Line	:	SUITE 440
City	:	ROSWELL
State	:	GA
Zip	:	30076-2575
Country	:	US
Telephone Number	:	770-552-1535
Fax Number	:	678-353-3211

Provider Business Practice Location Address
First Line	:	1000 HOLCOMB WOODS PKWY
Second Line	:	SUITE 440
City	:	ROSWELL
State	:	GA
Zip	:	30076-2575
Country	:	US
Telephone Number	:	770-552-1535
Fax Number	:	678-353-3211

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

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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Directions to “ SHAUNA COURTNEY BCBA” Practice Location

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