Provider Demographics
NPI:1659947026
Name:MCCOY, BRYCE AARON (BCBA)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:AARON
Last Name:MCCOY
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 1:1155 HEMBREE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4635
Mailing Address - Country:US
Mailing Address - Phone:770-250-0093
Mailing Address - Fax:
Practice Address - Street 1:1155 HEMBREE RD STE 210
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4635
Practice Address - Country:US
Practice Address - Phone:770-250-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-29149103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst