Cortney Simo Fossouo, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-20-45990 Issued in TX

Practice address

611 S Highway 78 Ste 124
Wylie, TX 75098-4134

Phone

(972) 429-5700

NPI assigned

Oct 31, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Cortney Sales Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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

• Thrive Advanced Care LLC

  • Behavior Analyst
  • Wylie, TX
  • NPI 1447903893
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1609388578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 KAMBER LN",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750984539",
            "telephone_number": "214-454-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 S HIGHWAY 78 STE 124",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750984134",
            "telephone_number": "972-429-5700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15820 Addison Rd",
            "address_purpose": "LOCATION",
            "city": "Addison",
            "state": "TX",
            "postal_code": "750013549",
            "country_code": "US",
            "telephone_number": "214-575-2999",
            "fax_number": "214-575-2999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "406 Kamber Ln",
            "address_purpose": "LOCATION",
            "city": "Wylie",
            "state": "TX",
            "postal_code": "750984539",
            "country_code": "US",
            "telephone_number": "214-454-2447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMO FOSSOUO",
        "first_name": "CORTNEY",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-31",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "1-20-45990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORTNEY",
            "last_name": "SALES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in Wylie, TX
• Providers in Wylie, TX by specialty
• Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.