Active NPI
Justin McDaniel
- Behavior Analyst
- Bowling Green, KY
National Provider Identifier
1730594631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- ABALBA00218345
- Practice address
- 181 W Professional Park CT Ste 1
Bowling Green, KY 42104-3250 - Phone
- (270) 843-5300
- Fax
- (270) 843-5383
- NPI assigned
- Jun 30, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | ABALBA00218345 | KY | Primary |
Addresses
Primary practice location
181 W Professional Park CT Ste 1
Bowling Green, KY 42104-3250
Mailing address
PO Box 51322
Bowling Green, KY 42102-5622
Phone (270) 777-9283
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110026265E | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ABALBA00218345 | KY | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Living in Kentucky, LLC | Behavior Analyst | Past | Accepting new patients |
| Gateway Counseling Services | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- Murray, KY
- NPI 1518281419
Behavior Analyst
-
- Community/Behavioral Health Agency
- Bowling Green, KY
- NPI 1508278458
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453334400000",
"number": "1730594631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 51322",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421025622",
"telephone_number": "270-777-9283",
"fax_number": "270-777-9283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "181 W PROFESSIONAL PARK CT STE 1",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421043250",
"telephone_number": "270-843-5300",
"fax_number": "270-843-5383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDANIEL",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-30",
"last_updated": "2016-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "KY",
"license": "ABALBA00218345",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110026265E",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.