MEDICARE: ELIZABETH MICHELLE BRANDERHORST

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1265015747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MICHELLE BRANDERHORST

Provider Business Mailing Address
First Line	:	PO BOX 6451
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59406-6451
Country	:	US
Telephone Number	:	406-240-2045
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 BROADWAY AVE
Second Line	:	SUITE B-535
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2214
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	12/19/2025

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