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NPI Code Detail

MEDICARE: TRINA LANETTE PURDY BCBA

MEDICARE: TRINA LANETTE PURDY 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
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1922581974
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRINA LANETTE PURDY BCBA
Provider Business Mailing Address
First Line : 2675 COURT DR
Second Line :
City : GASTONIA
State : NC
Zip : 28054-1478
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16409 NORTHCROSS DR
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-5065
Country : US
Telephone Number : 704-960-1729
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2018
Last Update Date : 02/14/2024

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