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NPI Code Detail

MEDICARE: SHANNON SMITH M.ED, BCBA

MEDICARE:   SHANNON  SMITH  M.ED, 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 Analyst

General Provider Information

NPI Number : 1740618586
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON SMITH M.ED, BCBA
Provider Business Mailing Address
First Line : 20718 PARK ROW DR
Second Line :
City : KATY
State : TX
Zip : 77449-5181
Country : US
Telephone Number : 281-980-0642
Fax Number : 832-358-3530
Provider Business Practice Location Address
First Line : 20718 PARK ROW DR
Second Line :
City : KATY
State : TX
Zip : 77449-5181
Country : US
Telephone Number : 281-980-0642
Fax Number : 832-358-3530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2013
Last Update Date : 10/29/2014

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Directions to “ SHANNON SMITH M.ED, BCBA” Practice Location

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