Provider Demographics
NPI:1164842563
Name:PEPPERS-OWEN, COURTNEY S (BCBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:S
Last Name:PEPPERS-OWEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 CHURCH AVE SE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2918
Mailing Address - Country:US
Mailing Address - Phone:256-452-4643
Mailing Address - Fax:
Practice Address - Street 1:1412 CHURCH AVE SE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-2918
Practice Address - Country:US
Practice Address - Phone:256-452-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst