MEDICARE: CASSIDY ANDERSON 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

General Provider Information

NPI Number	:	1922526938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY ANDERSON BCBA

Provider Business Mailing Address
First Line	:	10931 STONE HOUSE LN
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-8055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10931 STONE HOUSE LN
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-8055
Country	:	US
Telephone Number	:	214-632-4256
Fax Number	:

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	11/28/2023

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