=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497566632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEATIFIC BEHAVIOR SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2025
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 416 W LINDEN AVE
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-223-7943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 416 W LINDEN AVE
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-223-7943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NIKKI BURTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-223-7943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------