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General NPI Number Information
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NPI Number | 1134854086
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Entity Type | Organization
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Legal Business Name | BECOME, BEHAVIORAL & EDUCATIONAL SERVICES & TRAINING, LLC
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 5601 SUNNYBROOK DR.
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City | SIOUX CITY
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State | IA
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Zip | 51106
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Country | US
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Telephone | 712-746-7477
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Fax | 712-202-2989
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Provider Business Mailing Address
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Address Line | 3127 JONES ST
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City | SIOUX CITY
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State | IA
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Zip | 51104-2753
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Country | US
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Telephone | 712-259-1084
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEAH CLARK
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Credential | ED.S, BCBA, LBA
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Telephone | 712-259-1084
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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 |
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License Number State |
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