MEDICARE: TRISHA BRAECKLEIN 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
1	103K00000X	Behavior Analyst	1-17-26155	VA

General Provider Information

NPI Number	:	1588821730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA BRAECKLEIN BCBA

Provider Business Mailing Address
First Line	:	301 PERKINS DR STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3248
Country	:	US
Telephone Number	:	575-526-6682
Fax Number	:	575-523-7254

Provider Business Practice Location Address
First Line	:	1675 HICKORY LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-6587
Country	:	US
Telephone Number	:	575-652-3155
Fax Number	:	505-715-4958

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	03/25/2026

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