Provider Demographics
NPI:1295966851
Name:BIRDWELL, COURTNEY HANNAH (BCBA)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:HANNAH
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:341 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-8904
Mailing Address - Country:US
Mailing Address - Phone:615-708-4739
Mailing Address - Fax:
Practice Address - Street 1:341 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-8904
Practice Address - Country:US
Practice Address - Phone:615-708-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program