Provider Demographics
NPI:1366270829
Name:KOOP, BRIANNA (BCBA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:KOOP
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 1:136 HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-4235
Mailing Address - Country:US
Mailing Address - Phone:507-313-2056
Mailing Address - Fax:
Practice Address - Street 1:188 GREENFIELD LN
Practice Address - Street 2:
Practice Address - City:CASTALIAN SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37031-4751
Practice Address - Country:US
Practice Address - Phone:615-415-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst