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General NPI Number Information
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NPI Number | 1053872952
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Entity Type | Individual
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Provider Name | TEEONNA COLDCLEUGH BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 1585 N 113TH AVE STE 102
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City | AVONDALE
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State | AZ
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Zip | 85392-3938
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Country | US
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Telephone | 623-204-1701
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Fax |
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Provider Business Mailing Address
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Address Line | 6232 N 7TH ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85014-1850
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Country | US
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Telephone | 623-693-2954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-80760
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BEH-001068
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License Number State | AZ
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