Provider Demographics
NPI:1447918271
Name:THOMPSON, COURTNEY TAYLOR (BCBA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26116 STARLING HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2461
Mailing Address - Country:US
Mailing Address - Phone:210-630-8157
Mailing Address - Fax:
Practice Address - Street 1:26116 STARLING HL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-2461
Practice Address - Country:US
Practice Address - Phone:210-630-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB398421103K00000X
HIBA-787-0103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBA398421OtherBCBA
HI006373Medicaid
HIBA-787-0OtherBCBA