MEDICARE: CAROLYN PARNELL. SANDFORD

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1912496126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN PARNELL. SANDFORD

Provider Business Mailing Address
First Line	:	6919 GRAPEVINE LK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1109
Country	:	US
Telephone Number	:	121-995-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	6919 GRAPEVINE LK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1109
Country	:	US
Telephone Number	:	121-885-0122
Fax Number	:

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

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	05/02/2018

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