Healthcare Provider Details

I. General information

NPI: 1679112049
Provider Name (Legal Business Name): AUTUMN MARIE MCVEIGH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUTUMN MARIE PARKER

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 DEPOT DRIVE
ANCHORAGE AK
99501-1615
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6747
  • Fax: 772-675-9100
Mailing address:
  • Phone: 855-832-6747
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number261316
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: