MEDICARE: LALEH BEIJAN BCBA, LBA

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

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

General Provider Information

NPI Number	:	1669710125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LALEH BEIJAN BCBA, LBA

Provider Business Mailing Address
First Line	:	10585 MEDICINE BOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4906
Country	:	US
Telephone Number	:	757-672-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	10585 MEDICINE BOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4906
Country	:	US
Telephone Number	:	757-672-4174
Fax Number	:

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

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2023

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