Provider Demographics
NPI:1013368356
Name:BROOME, COURTNEY JAMES (BCBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JAMES
Last Name:BROOME
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9577 E BLUE RIDGE MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6648
Mailing Address - Country:US
Mailing Address - Phone:520-241-8063
Mailing Address - Fax:
Practice Address - Street 1:401 N BONITA AVE STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2750
Practice Address - Country:US
Practice Address - Phone:520-721-1887
Practice Address - Fax:520-372-7126
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000636103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1-20-45718OtherBACB
AZBEH-000636OtherAZ BOARD OF PHYCOLOGIST EXAMINERS