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Mariah Lynne Avery, BCBA

Individual provider Active NPI Behavior Analyst · Bainbridge, GA

NPI 1487183752 · NPPES record last updated Jan 10, 2024

Key facts

NPI
1487183752
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Analyst 103K00000X
License
1-18-29947 (GA)
Practice address
188 Robin LN
Bainbridge, GA 39819-6465
Phone
(229) 726-5311
Fax
(229) 231-3022
NPI assigned
Jun 8, 2017
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Bridge Behavior Consulting LLC Behavior Analyst Current
since Jan 14, 2024		 Accepting new patients
Behavior Management Consultants, Inc Behavior Analyst Past
since Nov 29, 2020		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-18-29947 GA Yes
Behavior Analyst 103K00000X

Addresses

Primary practice location

188 Robin LN
Bainbridge, GA 39819-6465

Mailing address

188 Robin LN
Bainbridge, GA 39819-6465
Phone (229) 726-5311

Other providers in Bainbridge, GA

All providers in Bainbridge, GA · Behavior Analyst in Georgia

Sources for this page

Verify at the official NPI Registry.