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NPI Code Detail

MEDICARE: MICHELLE LIDDELL BCBA

MEDICARE: MICHELLE LIDDELL 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 Analyst1-20-44884CA

General Provider Information

NPI Number : 1851808745
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LIDDELL BCBA
Provider Business Mailing Address
First Line : 1000 CALLE AMANECER
Second Line :
City : SAN CLEMENTE
State : CA
Zip : 92673-6214
Country : US
Telephone Number : 949-929-3572
Fax Number :
Provider Business Practice Location Address
First Line : 1000 CALLE AMANECER
Second Line :
City : SAN CLEMENTE
State : CA
Zip : 92673-6214
Country : US
Telephone Number : 949-929-3572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2018
Last Update Date : 03/04/2025

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