Healthcare Provider Details

I. General information

NPI: 1154036796
Provider Name (Legal Business Name): JOSEPHINE LIES RBT, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5627 NW 86TH ST STE 300
JOHNSTON IA
50131-2605
US

IV. Provider business mailing address

11635 NW BEAVER DR
GRANGER IA
50109-9762
US

V. Phone/Fax

Practice location:
  • Phone: 515-304-9545
  • Fax:
Mailing address:
  • Phone: 319-883-6556
  • Fax:

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 NumberBA-01575
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: