MEDICARE: STEPHANIE BOUGRAT

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	LBA002189	GA
2	106S00000X	Behavior Technician		TN

General Provider Information

NPI Number	:	1649981150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BOUGRAT

Provider Business Mailing Address
First Line	:	1691 NORTHPOINT BLVD
Second Line	:	SUITE 160
City	:	HIXSON
State	:	TN
Zip	:	37343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1691 NORTHPOINT BLVD
Second Line	:	SUITE 160
City	:	HIXSON
State	:	TN
Zip	:	37343
Country	:	US
Telephone Number	:	423-498-9051
Fax Number	:

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

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	03/02/2026

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Directions to “ STEPHANIE BOUGRAT ” Practice Location

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