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NPI Code Detail

MEDICARE: BREANA DAVIS BCBA

MEDICARE: BREANA DAVIS 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 : 1770310575
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANA DAVIS BCBA
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15755 N POINTE BLVD
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46060-4388
Country : US
Telephone Number : 574-387-4313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2024
Last Update Date : 09/16/2024

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Directions to “ BREANA DAVIS BCBA” Practice Location

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