Provider Demographics
NPI:1053926758
Name:LEE, BETHANY JOYANNA (BCBA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOYANNA
Last Name:LEE
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 1:7610 E PALMER WASILLA HWY
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8467
Mailing Address - Country:US
Mailing Address - Phone:907-903-1949
Mailing Address - Fax:
Practice Address - Street 1:7610 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8467
Practice Address - Country:US
Practice Address - Phone:907-206-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK200945106E00000X
106S00000X
AK243817103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician