MEDICARE: MACKENZIE BEABOUT 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1346773223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE BEABOUT BCBA

Provider Business Mailing Address
First Line	:	1817 WELLSPRING AVE SE STE D
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4956
Country	:	US
Telephone Number	:	505-828-3837
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 WELLSPRING AVE SE STE D
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4956
Country	:	US
Telephone Number	:	383-750-5828
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	07/31/2023

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Directions to “ MACKENZIE BEABOUT BCBA” Practice Location

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