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NPI Code Detail

MEDICARE: LIA VIOLET BECKTOLD M.ED., BCBA

MEDICARE: LIA VIOLET BECKTOLD M.ED., 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 AnalystBEH-000212AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21-15-19569OTHERBCBA CERTIFICATE

General Provider Information

NPI Number : 1760855696
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIA VIOLET BECKTOLD M.ED., BCBA
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 5859 W TALAVI BLVD STE 180
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-1873
Country : US
Telephone Number : 602-560-2836
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2015
Last Update Date : 01/03/2020

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