MEDICARE: MILESTONES BEHAVIOR GROUP

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	RBT-17-41780	AL

General Provider Information

NPI Number	:	1457867541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONES BEHAVIOR GROUP

Provider Business Mailing Address
First Line	:	877 OLD MILL RD N
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-7606
Country	:	US
Telephone Number	:	256-689-7023
Fax Number	:

Provider Business Practice Location Address
First Line	:	3296 CAHABA HEIGHTS RD # 20
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-1653
Country	:	US
Telephone Number	:	205-253-6903
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	ASHLIE WALKER
Credential	:	MS, BCBA
Telephone Number	:	205-253-6903

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	12/27/2017

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