MEDICARE: SUNNY LOUISE MUIRHEAD 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	1-21-54864

General Provider Information

NPI Number	:	1457075400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNY LOUISE MUIRHEAD BCBA

Provider Business Mailing Address
First Line	:	1404 W IDAHO ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5002
Country	:	US
Telephone Number	:	208-968-7470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 W IDAHO ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5002
Country	:	US
Telephone Number	:	208-968-7470
Fax Number	:

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2023

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Directions to “ SUNNY LOUISE MUIRHEAD BCBA” Practice Location

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