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NPI Code Detail

MEDICARE: MRS. BETHANY JOANN BROOKS BCBA

MEDICARE: MRS. BETHANY JOANN BROOKS 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 Analyst

General Provider Information

NPI Number : 1851964043
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETHANY JOANN BROOKS BCBA
Provider Business Mailing Address
First Line : 1525 MERRILL DR STE 100
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-1665
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1525 MERRILL DR STE 100
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-1665
Country : US
Telephone Number : 870-219-0370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2021
Last Update Date : 07/23/2021

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