MEDICARE: RESHANAE L CRIFT BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-21-47669	AR

General Provider Information

NPI Number	:	1043681398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESHANAE L CRIFT BCBA

Provider Business Mailing Address
First Line	:	16401 CHENAL VALLEY DR APT 2307
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-3928
Country	:	US
Telephone Number	:	870-723-3514
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 FOUNTAIN DR STE 100
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3690
Country	:	US
Telephone Number	:	501-269-1656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	12/08/2025

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