Provider Demographics
NPI:1346773223
Name:BEABOUT, MACKENZIE (BCBA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BEABOUT
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 1:1817 WELLSPRING AVE SE STE D
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4956
Mailing Address - Country:US
Mailing Address - Phone:505-828-3837
Mailing Address - Fax:
Practice Address - Street 1:1817 WELLSPRING AVE SE STE D
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4956
Practice Address - Country:US
Practice Address - Phone:383-750-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician