Healthcare Provider Details

I. General information

NPI: 1689215121
Provider Name (Legal Business Name): BELLE ILE BUCHEL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 PENNSYLVANIA AVE
MCDONOUGH GA
30253-9110
US

IV. Provider business mailing address

675 HENSON FARM DR
LOGANVILLE GA
30052-6528
US

V. Phone/Fax

Practice location:
  • Phone: 404-465-1650
  • Fax:
Mailing address:
  • Phone: 561-529-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54037
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: