Healthcare Provider Details

I. General information

NPI: 1053926758
Provider Name (Legal Business Name): BETHANY JOYANNA LEE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 N BIRDSELL DR UNIT B
WASILLA AK
99623-9307
US

IV. Provider business mailing address

1732 N BIRDSELL DR UNIT B
WASILLA AK
99623-9307
US

V. Phone/Fax

Practice location:
  • Phone: 907-903-1949
  • Fax:
Mailing address:
  • Phone: 907-715-6386
  • Fax: 855-265-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number243817
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number200945
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: