Provider Demographics
NPI:1497277586
Name:ROBERTS, COURTNEY BRIANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BRIANNE
Last Name:ROBERTS
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 1:118 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-4276
Mailing Address - Country:US
Mailing Address - Phone:319-431-7175
Mailing Address - Fax:
Practice Address - Street 1:118 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-4276
Practice Address - Country:US
Practice Address - Phone:319-431-7175
Practice Address - Fax:319-431-7175
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-23067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst