Healthcare Provider Details

I. General information

NPI: 1205588282
Provider Name (Legal Business Name): KARISSA BEUTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LIONS DR
NORTH LIBERTY IA
52317-9575
US

IV. Provider business mailing address

3 LIONS DR
NORTH LIBERTY IA
52317-9575
US

V. Phone/Fax

Practice location:
  • Phone: 574-607-4511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberABA-01002
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: