Provider Demographics
NPI:1154750248
Name:BEZILLA, BRAD SCOTT (BCBA)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:SCOTT
Last Name:BEZILLA
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Gender:M
Credentials:BCBA
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Mailing Address - Street 1:1625 ADVENTURELAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2237
Mailing Address - Country:US
Mailing Address - Phone:515-967-4369
Mailing Address - Fax:515-957-3380
Practice Address - Street 1:1661 BOYSON SQUARE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2311
Practice Address - Country:US
Practice Address - Phone:319-294-9577
Practice Address - Fax:515-957-3380
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst