Provider Demographics
NPI:1093203317
Name:KEUP, ERIN (BCBA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KEUP
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 E RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4556
Mailing Address - Country:US
Mailing Address - Phone:757-416-8540
Mailing Address - Fax:719-890-7205
Practice Address - Street 1:5475 MARK DABLING BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3847
Practice Address - Country:US
Practice Address - Phone:757-416-8540
Practice Address - Fax:719-890-7205
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X
CO1-21-50661103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician