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NPI Code Detail

MEDICARE: TRISHA BRAECKLEIN BCBA

MEDICARE: TRISHA BRAECKLEIN 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
1103K00000XBehavior Analyst1-17-26155NM

General Provider Information

NPI Number : 1588821730
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISHA BRAECKLEIN BCBA
Provider Business Mailing Address
First Line : 301 PERKINS DR STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3248
Country : US
Telephone Number : 575-526-6682
Fax Number : 575-523-7254
Provider Business Practice Location Address
First Line : 1675 HICKORY LOOP
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-6587
Country : US
Telephone Number : 575-652-3155
Fax Number : 505-715-4958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2008
Last Update Date : 02/07/2022

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Directions to “ TRISHA BRAECKLEIN BCBA” Practice Location

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