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General NPI Number Information
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NPI Number | 1457746091
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Entity Type | Individual
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Provider Name | DOUGLAS BOE BCBA
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Gender | Male
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 1001 FORT CROOK RD N STE 204
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City | BELLEVUE
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State | NE
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Zip | 68005-4226
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Country | US
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Telephone | 402-934-1084
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 JEFFERSON ST NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1734
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Country | US
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Telephone | 402-575-7556
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-09-5082
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License Number State | NE
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