Provider Demographics
NPI:1467028704
Name:STEPHENS, BREANNA RENEE (BCBA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:RENEE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 EFURD LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72940-9561
Mailing Address - Country:US
Mailing Address - Phone:479-739-6204
Mailing Address - Fax:
Practice Address - Street 1:5400 EUPER LN
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3232
Practice Address - Country:US
Practice Address - Phone:479-755-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1-22-62026103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst