MEDICARE: ELIZABETH KUNZ 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	277969	OTHER		BACB

General Provider Information

NPI Number	:	1558858274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KUNZ BCBA

Provider Business Mailing Address
First Line	:	525 S CHURCH ST APT 3707
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-3345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17206 LANCASTER HWY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2003
Country	:	US
Telephone Number	:	757-274-9403
Fax Number	:

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

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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