Provider Demographics
NPI:1679133946
Name:DURAN-MEDINA, BRANDI K (BCBA)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:K
Last Name:DURAN-MEDINA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:K
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-8511
Mailing Address - Country:US
Mailing Address - Phone:931-412-3500
Mailing Address - Fax:615-624-7318
Practice Address - Street 1:410 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-8511
Practice Address - Country:US
Practice Address - Phone:931-412-3500
Practice Address - Fax:615-624-7318
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TN502103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty