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NPI Code Detail

MEDICARE: LISA EBERLY BCABA, LABA

MEDICARE: LISA EBERLY BCABA, LABA
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
1101Y00000XCounselor
2106E00000XAssistant Behavior Analyst10673594-2507UT

General Provider Information

NPI Number : 1114393212
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA EBERLY BCABA, LABA
Provider Business Mailing Address
First Line : 6013 S REDWOOD RD
Second Line :
City : TAYLORSVILLE
State : UT
Zip : 84123-5220
Country : US
Telephone Number : 801-255-5131
Fax Number : 801-255-5131
Provider Business Practice Location Address
First Line : 1858 W 5150 S
Second Line :
City : ROY
State : UT
Zip : 84067-3000
Country : US
Telephone Number : 801-255-5131
Fax Number : 801-658-0604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2015
Last Update Date : 04/12/2022

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Directions to “ LISA EBERLY BCABA, LABA” Practice Location

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