NPIMap

Individual provider Active NPI

Jeanette Birk

  • Behavior Analyst
  • Peoria, AZ
National Provider Identifier
1205505229
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
BEH-000794 Issued in AZ
Practice address
20470 N Lake Pleasant Rd Ste 107
Peoria, AZ 85382-9708
Phone
(623) 248-3324
NPI assigned
Sep 13, 2021
Last updated
Sep 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X BEH-000794 AZ Primary

Addresses

Primary practice location

20470 N Lake Pleasant Rd Ste 107
Peoria, AZ 85382-9708

Mailing address

20470 N Lake Pleasant Rd Ste 107
Peoria, AZ 85382-9708
Phone (623) 248-3324

Other identifiers 1

IdentifierTypeStateIssuer
BEH-000794OtherAZARIZONA STATE BOARD OF PSYCHOLOGIST EXAMINERS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
BEH-000794AZMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
The Devereux Foundation Past Accepting new patients
The Devereux Foundation Past Accepting new patients
Action Behavior Centers Therapy LLC Behavior Analyst Past Accepting new patients
Action Behavior Centers, LLC Behavior Analyst Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1205505229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20470 N LAKE PLEASANT RD STE 107",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829708",
            "telephone_number": "623-248-3324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20470 N LAKE PLEASANT RD STE 107",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829708",
            "telephone_number": "623-248-3324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRK",
        "first_name": "JEANETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "AZ",
            "license": "BEH-000794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA STATE BOARD OF PSYCHOLOGIST EXAMINERS",
            "identifier": "BEH-000794",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.