MEDICARE: MEGHAN NICOLE NAUCK 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	1-17-28480
2	106E00000X	Assistant Behavior Analyst	8737	TX

General Provider Information

NPI Number	:	1699286161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN NICOLE NAUCK BCBA

Provider Business Mailing Address
First Line	:	1711 E CENTRAL TEXAS EXPY STE 302
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76541-9147
Country	:	US
Telephone Number	:	678-467-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 S W S YOUNG DR STE 105
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-2007
Country	:	US
Telephone Number	:	678-467-8484
Fax Number	:

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

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	08/02/2023

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