Provider Demographics
NPI:1104066612
Name:FEENEY, BRIAN JAMES (MA, BCBA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:FEENEY
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10399 DOUBLE R BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5991
Mailing Address - Country:US
Mailing Address - Phone:269-762-2075
Mailing Address - Fax:719-452-3461
Practice Address - Street 1:10399 DOUBLE R BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5991
Practice Address - Country:US
Practice Address - Phone:269-762-2075
Practice Address - Fax:719-452-3461
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4678103K00000X
NVLBA0024103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst