Healthcare Provider Details

I. General information

NPI: 1326559352
Provider Name (Legal Business Name): AUSTIN YEATER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W JEFFERSON AVE STE 202
LAKEWOOD CO
80235-2023
US

IV. Provider business mailing address

7220 W JEFFERSON AVE STE 202
LAKEWOOD CO
80235-2023
US

V. Phone/Fax

Practice location:
  • Phone: 309-502-9514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31703
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: