Provider Demographics
NPI:1508350356
Name:BRIANA MCKINNEY, BCBA, MT-BC
Entity Type:Organization
Organization Name:BRIANA MCKINNEY, BCBA, MT-BC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, MT-BC
Authorized Official - Phone:216-926-9215
Mailing Address - Street 1:13458 MARION ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1950
Mailing Address - Country:US
Mailing Address - Phone:216-926-9215
Mailing Address - Fax:
Practice Address - Street 1:13458 MARION ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-1950
Practice Address - Country:US
Practice Address - Phone:216-926-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-18384103K00000X
CO09788225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO286842404Medicaid