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NPI Code Detail

MEDICARE: MIRACLE WEBB BCBA

MEDICARE: MIRACLE WEBB 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 Analyst

General Provider Information

NPI Number : 1356011688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRACLE WEBB BCBA
Provider Business Mailing Address
First Line : 8920 STONE GREEN WAY STE 100
Second Line :
City : LOUISVILLE
State : KY
Zip : 40220-4072
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8920 STONE GREEN WAY STE 100
Second Line :
City : LOUISVILLE
State : KY
Zip : 40220-4072
Country : US
Telephone Number : 502-915-8343
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2021
Last Update Date : 02/03/2026

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