Provider Demographics
NPI:1922557529
Name:COPELAND, BIANCA (MED BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 CORN HILL DR
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1379
Mailing Address - Country:US
Mailing Address - Phone:512-966-1810
Mailing Address - Fax:
Practice Address - Street 1:4007 MARATHON BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3717
Practice Address - Country:US
Practice Address - Phone:512-966-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-23075103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst