MEDICARE: DAMON MONTRELL MCCASKILL JR.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1881487148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMON MONTRELL MCCASKILL JR.

Provider Business Mailing Address
First Line	:	19645 N 31ST AVE APT 3036
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3994
Country	:	US
Telephone Number	:	310-330-6173
Fax Number	:

Provider Business Practice Location Address
First Line	:	8444 N 90TH ST STE 130
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4440
Country	:	US
Telephone Number	:	480-567-0160
Fax Number	:

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

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	05/28/2025

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