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General NPI Number Information
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NPI Number | 1083134530
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Entity Type | Organization
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Legal Business Name | KIMBERLY BESSETTE, MA, BCBA
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 122 GALENA COURT
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City | DRAKE
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State | CO
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Zip | 80515-0188
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Country | US
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Telephone | 970-631-5241
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Fax | 970-631-5241
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Provider Business Mailing Address
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Address Line | PO BOX 188, 122 GALENA COURT
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City | DRAKE
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State | CO
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Zip | 80515-0188
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Country | US
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Telephone | 970-631-5241
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY KAYE BESSETTE
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Credential | BCBA
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Telephone | 970-631-5241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-08-4622
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License Number State | CO
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