Provider Demographics
NPI:1699423475
Name:BEEBOUT, JUDITH ELISE (BCBA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELISE
Last Name:BEEBOUT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:J.
Other - Middle Name:ELISE
Other - Last Name:BEEBOUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:719 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-3583
Mailing Address - Country:US
Mailing Address - Phone:317-762-2917
Mailing Address - Fax:
Practice Address - Street 1:719 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-3583
Practice Address - Country:US
Practice Address - Phone:317-762-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
INBACB770381OtherBEHAVIOR ANALYST CERTIFICATION