Provider Demographics
NPI:1255729703
Name:COALE, BRIANNA L (MS ED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:L
Last Name:COALE
Suffix:
Gender:F
Credentials:MS ED, BCBA, LBA
Other - Prefix:
Other - First Name:BRIA
Other - Middle Name:
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3051 E SWALLOW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6658
Mailing Address - Country:US
Mailing Address - Phone:417-599-0706
Mailing Address - Fax:
Practice Address - Street 1:3828 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5285
Practice Address - Country:US
Practice Address - Phone:417-414-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013017320103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst