MEDICARE: ELIZABETH SCOUTE CRIST 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	BA-984	HI

General Provider Information

NPI Number	:	1336739952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SCOUTE CRIST BCBA

Provider Business Mailing Address
First Line	:	128 LEY CT
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3404
Country	:	US
Telephone Number	:	530-643-1308
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 LEY CT
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3404
Country	:	US
Telephone Number	:	530-643-1308
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	05/30/2026

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