MEDICARE: BRANDI STALLONS 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

General Provider Information

NPI Number	:	1316479140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI STALLONS BCBA

Provider Business Mailing Address
First Line	:	2002 S VIRGINIA ST
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-3612
Country	:	US
Telephone Number	:	918-991-5199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 S VIRGINIA ST STE 100
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-6008
Country	:	US
Telephone Number	:	270-874-5131
Fax Number	:

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	06/30/2023

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