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NPI Code Detail

MEDICARE: CARISSA NICOLE PENNY BCBA

MEDICARE: CARISSA NICOLE PENNY 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
1103K00000XBehavior Analyst2441TX

General Provider Information

NPI Number : 1629375571
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA NICOLE PENNY BCBA
Provider Business Mailing Address
First Line : 2740 COLLEGE AVE
Second Line :
City : CONWAY
State : AR
Zip : 72034-6141
Country : US
Telephone Number : 501-329-5459
Fax Number : 501-327-1738
Provider Business Practice Location Address
First Line : 6025 SPORTS VILLAGE RD
Second Line :
City : FRISCO
State : TX
Zip : 75033-3505
Country : US
Telephone Number : 214-687-9374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2011
Last Update Date : 02/13/2019

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Directions to “ CARISSA NICOLE PENNY BCBA” Practice Location

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