Provider Demographics
NPI:1083134530
Name:KIMBERLY BESSETTE, MA, BCBA
Entity Type:Organization
Organization Name:KIMBERLY BESSETTE, MA, BCBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BESSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:970-631-5241
Mailing Address - Street 1:PO BOX 188, 122 GALENA COURT
Mailing Address - Street 2:
Mailing Address - City:DRAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80515-0188
Mailing Address - Country:US
Mailing Address - Phone:970-631-5241
Mailing Address - Fax:
Practice Address - Street 1:122 GALENA COURT
Practice Address - Street 2:
Practice Address - City:DRAKE
Practice Address - State:CO
Practice Address - Zip Code:80515-0188
Practice Address - Country:US
Practice Address - Phone:970-631-5241
Practice Address - Fax:970-631-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-08-4622103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty