MEDICARE: SHAYQUANA GLOVER 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	1-21-49450	TX

General Provider Information

NPI Number	:	1306428560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYQUANA GLOVER BCBA

Provider Business Mailing Address
First Line	:	6711 MORNING GLORY TRCE
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2063
Country	:	US
Telephone Number	:	281-788-7387
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 MORNING GLORY TRCE
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2063
Country	:	US
Telephone Number	:	281-788-7387
Fax Number	:

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

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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