MEDICARE: HAVEN NICOLE BUSBEE 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	1-23-68792	GA

General Provider Information

NPI Number	:	1407518590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAVEN NICOLE BUSBEE BCBA

Provider Business Mailing Address
First Line	:	500 CONGAREE RD APT 7229
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4770
Country	:	US
Telephone Number	:	843-461-0831
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 ROPER MOUNTAIN RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4236
Country	:	US
Telephone Number	:	864-256-4067
Fax Number	:	912-200-5712

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

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	06/24/2024

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