MEDICARE: TYKEEM POE 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	4098	NC

General Provider Information

NPI Number	:	1699356592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYKEEM POE BCBA

Provider Business Mailing Address
First Line	:	519 COOLEY DR
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28147-0051
Country	:	US
Telephone Number	:	704-954-4096
Fax Number	:

Provider Business Practice Location Address
First Line	:	9710 NORTHCROSS CENTER CT
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7342
Country	:	US
Telephone Number	:	980-529-7037
Fax Number	:

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	03/12/2026

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Directions to “ TYKEEM POE BCBA” Practice Location

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