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NPI Code Detail

MEDICARE: MR. DANIEL BRYAN DYESS

MEDICARE: MR. DANIEL BRYAN DYESS
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
1106E00000XAssistant Behavior Analyst252001MS
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1376167262
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL BRYAN DYESS
Provider Business Mailing Address
First Line : 296 BEAUVOIR RD STE 100-1311
Second Line :
City : BILOXI
State : MS
Zip : 39531-4051
Country : US
Telephone Number : 228-707-4417
Fax Number : 228-678-7877
Provider Business Practice Location Address
First Line : 6017 WASHINGTON AVE
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-2648
Country : US
Telephone Number : 228-218-1242
Fax Number : 228-678-7877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2020
Last Update Date : 02/25/2025

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