MEDICARE: DANIELLE FAITH STANLEY 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	0-11-4367

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0-11-4367	OTHER		BACB CERTIFICATION

General Provider Information

NPI Number	:	1831465129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE FAITH STANLEY BCBA

Provider Business Mailing Address
First Line	:	3760 CRANSWOOD WAY
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80918-6332
Country	:	US
Telephone Number	:	719-213-4630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 S PERRY ST STE 100
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1969
Country	:	US
Telephone Number	:	720-949-7815
Fax Number	:

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

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	10/14/2024

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