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NPI Code Detail

MEDICARE: MICHELLE EATON LBA, BCBA

MEDICARE:   MICHELLE  EATON  LBA, 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
1106S00000XBehavior TechnicianRBT-15-02833CA
2106S00000XBehavior Technician00001169CA
3103K00000XBehavior Analyst1-18-33607CA

General Provider Information

NPI Number : 1104326305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE EATON LBA, BCBA
Provider Business Mailing Address
First Line : 9208 N 43RD AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85302-3852
Country : US
Telephone Number : 602-842-7218
Fax Number :
Provider Business Practice Location Address
First Line : 9208 N 43RD AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85302-3852
Country : US
Telephone Number : 602-842-7218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 02/20/2025

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Directions to “ MICHELLE EATON LBA, BCBA” Practice Location

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