MEDICARE: BRADFORD MICHAEL BEEBE PHD, HSPP, BCBA-D

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	101602	KY
2	103K00000X	Behavior Analyst	COBA.122	OH
3	103T00000X	Psychologist	128036	KY
4	103T00000X	Psychologist	0834	KY
5	103TC0700X	Clinical Psychologist	20040970A	IN
6	103TC0700X	Clinical Psychologist	128036	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1-04-2089	OTHER		BCBA-D CERTIFICATE

General Provider Information

NPI Number	:	1356344469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD MICHAEL BEEBE PHD, HSPP, BCBA-D

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	765-454-9759

Provider Business Practice Location Address
First Line	:	355 QUARTERMASTER CT
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3670
Country	:	US
Telephone Number	:	812-258-9802
Fax Number	:	765-454-9759

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/22/2017

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Directions to “ BRADFORD MICHAEL BEEBE PHD, HSPP, BCBA-D” Practice Location

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