Active NPI
Willow Cheyenne Cousineau
- Behavior Technician
- Evans, GA
National Provider Identifier
1760220412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-362187
- Practice address
- 2550 Trade Center Dr Ste G
Evans, GA 30809-6167 - Phone
- (706) 723-8458
- Fax
- (706) 842-5340
- NPI assigned
- Jul 17, 2024
- Sex
- Unspecified or another gender identity
- 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 Technician | 106S00000X | RBT-24-362187 | GA | Primary |
Addresses
Primary practice location
2550 Trade Center Dr Ste G
Evans, GA 30809-6167
Mailing address
3840 Karleen Rd
Hephzibah, GA 30815-5714
Phone (706) 524-5259
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 |
|---|---|---|---|
| RBT-24-362187 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738195200000",
"number": "1760220412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3840 KARLEEN RD",
"city": "HEPHZIBAH",
"state": "GA",
"postal_code": "308155714",
"telephone_number": "706-524-5259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 TRADE CENTER DR STE G",
"city": "EVANS",
"state": "GA",
"postal_code": "308096167",
"telephone_number": "706-723-8458",
"fax_number": "706-842-5340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUSINEAU",
"first_name": "WILLOW",
"middle_name": "CHEYENNE",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2024-07-17",
"last_updated": "2025-01-30",
"certification_date": "2025-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "RBT-24-362187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.