Provider Demographics
NPI:1134621188
Name:ROGERS, BRITTANY (BCBA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:ROGERS
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:PO BOX 3854
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3854
Mailing Address - Country:US
Mailing Address - Phone:970-708-1217
Mailing Address - Fax:
Practice Address - Street 1:215 1/2 E COLORADO AVE 3A
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-3854
Practice Address - Country:US
Practice Address - Phone:970-708-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-17-25957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty