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NPI Code Detail

MEDICARE: ERIN KEUP BCBA

MEDICARE:   ERIN  KEUP  BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst1-21-50661CO

General Provider Information

NPI Number : 1093203317
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN KEUP BCBA
Provider Business Mailing Address
First Line : 733 E RIO GRANDE ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-4556
Country : US
Telephone Number : 757-416-8540
Fax Number : 719-890-7205
Provider Business Practice Location Address
First Line : 5475 MARK DABLING BLVD STE 102
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3847
Country : US
Telephone Number : 757-416-8540
Fax Number : 719-890-7205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2018
Last Update Date : 11/07/2024

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